Macleans.ca » Pregnancyhttp://www.macleans.ca
Canada's national weekly current affairs magazineSun, 02 Aug 2015 20:17:33 +0000en-UShourly1http://wordpress.org/?v=4.2.2The princess is home! The 8th, and last stage of the #GreatKateWaithttp://www.macleans.ca/society/the-princess-is-home-the-8th-and-last-stage-of-the-greatkatewait/
http://www.macleans.ca/society/the-princess-is-home-the-8th-and-last-stage-of-the-greatkatewait/#commentsSat, 02 May 2015 09:26:51 +0000http://www.macleans.ca/?p=712729Just as there are five stages of grief, there are eight stages of royal pregnancies. Patricia Treble explains.

A banner made by royal fan John Loughrey, aged 60, hangs stuck to a wall across the street from the Lindo Wing of St. Mary’s Hospital in London, Thursday, April 23, 2015. (Matt Dunham/AP)

There are five stages of grief, 12 steps in Alcoholics Anonymous and 21 parts to this year’s Tour de France.

For royal pregnancies, there are eight stages:

1. Idle speculation: No one has any idea if a royal is pregnant, so hey, let’s gossip. A year ago, rumours were flowing during Prince William and Kate’s tour of Australia and New Zealand. She put a swift end to the speculation by not only drinking wine, but also going on a rough river excursion.

2.Educated guesses: A mere four days before it was revealed that Kate was pregnant with her first child, I counted belt holes in three separate outfits—yes, this is the life of a royal specialist—and came to a conclusion. As I wrote at the time, “It could just be a confluence of fashion choices, but after this week I’ve changed my stock answer. Now it’s ‘We won’t know officially until they announce it, but I think she could pregnant.’ ”

3. The announcement: Both of Kate’s pregnancies were revealed well before the three month mark. The first when she was merely four to six weeks along, because she was in hospital with severe morning sickness. The second when she was around two months pregnant, again because she backed out of an engagement due to the same illness. This news sends the media rushing to calendars to shift vacations out of the arrival zone.

4. The last trimester: As her belly gets bigger and bigger, stories start appearing about baby carriages, nannies, her maternity leave, and where she’ll give birth. Her fashion is analyzed and evaluated. For this pregnancy, What Kate Wore created the definitive guide to Kate’s maternity clothes.

5. The last month: This is complicated because no royal reveals her exact due date. They aren’t idiots. Any such declaration will automatically spawn stories proclaiming she has two days to go or is two days over In March, royal officials briefed the press that the new baby was due in mid-to-late April. That’s it. So all those stories that authoritatively claimed her due date was April 25, or April 28, are just cannon fodder.

Speculation mounts about what name will be picked—Alice is touted this time—as well as possible godparents. As days tick by with no news, the approaches to Kensington Palace and Buckingham Palace are staked out. Royal watchers obsessively check their phones for official notice that Step 6 is here. No bit of news is too small to mention.

6. Labour: To turn Winston Churchill’s famous quote on its head, it’s not the end of the beginning, but perhaps the beginning of the end. Notification that Kate is in the Lindo Wing of St. Mary’s Hospital gives permission for all the news organizations to cover the new baby 24/7. Of course, there is no more news than in Step 5—aside from the fact that she’s in labour—but that’s never stopped news channels. The phase only ends with official word of the birth. For George, the news came so close to evening deadlines that newspapers were in a panic. Finally the news was broken, not by traditional notice on an easel at Buckingham Palace, but an email to the media. (Note: if the baby arrives after 10 p.m. local time, then there will be no news until 8 a.m. the next day. Why? Because great-granny has to be told before the public, and the 89-year-old likes a good night’s sleep. Also, she’s the Queen. Who is going to wake her up?)

7. Appearance: Around 24 hours after the birth, [UPDATE: this time, they left within 12 hours, posed for pictures, but answered no questions] the mother and dad will leave the hospital with their child. Usually they will pose for pictures, and answer a few questions before retreating behind palace walls. Interestingly, most royal mothers are far more careful with their appearance with the second child, than the first. This precedent was likely broken with Kate, who was professionally made up (hair and make-up) before leaving with George.

8. Naming the new Windsor: This can happen at any time in the first few days. There seems to be no rhyme or reason as to the timing. Most royal children have four first names, George has three. And that ends the #GreatKateWait, 2015 edition.

]]>http://www.macleans.ca/society/the-princess-is-home-the-8th-and-last-stage-of-the-greatkatewait/feed/0How a cheap, simple test could stop a pregnancy killerhttp://www.macleans.ca/society/health/cheap-simple-pre-eclampsia-test-could-stop-a-killer/
http://www.macleans.ca/society/health/cheap-simple-pre-eclampsia-test-could-stop-a-killer/#commentsThu, 21 Aug 2014 14:38:27 +0000http://www.macleans.ca/?p=593605Pre-eclampsia is a common and deadly complication of pregnancy worldwide, but that may be about to change

Pre-eclampsia is a disorder that affects pregnant women, putting their lives (and their babies) at risk. Alzheimer’s, on the other hand, is most often a disease of old age. These two conditions appear to have nothing in common, but a team of researchers has made a surprising discovery that suggests otherwise. Pre-eclampsia, a hypertensive disorder that remains one of the most deadly pregnancy complications, seems to be linked to Alzheimer’s, mad cow and other neurodegenerative diseases. This discovery could lead to new ways to diagnose and, maybe, one day to treat, a little-understood condition.

“Pre-eclampsia is a fascinating disorder,” says Dr. Irina Buhimschi, director of the Center for Perinatal Research at Nationwide Children’s Hospital in Ohio and lead author of the paper. “There have been so many theories,” she says, but the truth is, doctors still don’t have a good idea why certain women develop it during pregnancy and others don’t. (Risk seems to be higher among women expecting their first child, or those at an advanced maternal age.) Around the world, about 75,000 women die of pre-eclampsia each year—mostly in developing countries, where medical staff might be less equipped to catch it early. Untreated, it can lead to seizures, stroke, organ failure and death. Pre-eclampsia also accounts for many preterm deliveries; it’s only after delivery that the mother’s symptoms (including headaches, dizziness, swelling, vision problems and rapid weight gain) typically resolve themselves. When Buhimschi embarked on her training in obstetrics and gynecology, she says, “I never would have thought I’d be learning about diseases associated with old age.” Yet that is where her work has taken her: to Alzheimer’s.

In Canada, as elsewhere, doctors monitor pregnant women for telltale signs of pre-eclampsia, including high blood pressure and protein in the urine. That protein provided an important clue. Studying urine from pregnant women with pre-eclampsia, Buhimschi’s team saw it contained improperly folded proteins—something seen in diseases such as Alzheimer’s, Parkinson’s, frontotemporal dementia, as well as many cancers. Proteins are essential to virtually every cell in our bodies; to properly function, they fold themselves into precise three-dimensional shapes. Sometimes, for reasons scientists can’t yet explain, they begin to “misfold,” assuming the wrong shape and accumulating like toxic junk.

In pre-eclampsia, misfolded proteins seem to get blocked in transit between mother and baby, building up in the mother’s body in what Buhimschi likens to a “traffic jam.” Placentas of women with pre-eclampsia, she found, were clogged with misfolded protein deposits—like the brains of Alzheimer’s patients. “In the majority of women, symptoms recede once the fetus and placenta are delivered,” Buhimschi says. “If only the fetus is delivered, it’s not enough. The placenta has to be delivered, too.” Misfolded proteins in urine, it turns out, can be detected by a cheap commercial dye called Congo red, which is also used to stain plaques in the brains of Alzheimer’s patients during autopsy. That finding became the basis of a new test.

Dr. Kara Rood, maternal fetal medicine fellow at Ohio State University and a Canadian (she was born and raised in Nova Scotia’s Annapolis Valley) is collaborating with Buhimschi on some of this work. The urine test doctors currently use simply looks for the presence of protein, Rood says, which can be caused by many things: a urinary tract infection, diabetes, kidney disease or pre-eclampsia. The protein misfolding discovery has led to the development of a new test—the paper-based Congo red dot urine test, which identifies pre-eclampsia specifically. “You mix the dye and urine together and put a drop on a piece of paper,” says Rood. “If the patient has pre-eclampsia, Congo red attaches to the proteins, and a large red dot appears.” Not only is the test extremely simple, she adds, it’s “very cheap,” costing less than two cents per test. That makes it ideal for developing countries, and that’s where Rood and her team will deploy it.

In mid-August, a clinical trial will begin at Ohio State. Not long after, trials of the new urine test will follow in Bangladesh, Mexico and South Africa. (The project is funded under the Saving Lives at Birth program, of which the government-funded Grand Challenges Canada is a partner.) “This test could have a huge global impact, especially in lower-resource countries,” says Rood, who’s overseeing the trials. Meanwhile, Buhimschi’s discovery raises questions for future research, including how a pre-eclampsia diagnosis might affect women in years or decades to come. “Are they more susceptible to the protein misfolding diseases of old age, or are they protected against them?” Buhimschi wonders. “We need to study this.”

When Carrie (not her real name) was 33, she discovered she was pregnant for the fourth time. For the married Ottawa-area mother of three, the pregnancy was the product of an affair. They had used condoms all but once and, while she knew the risks of getting pregnant, they seemed small, given her age and the fact that she’d struggled with serious health complications in her last two pregnancies. “I had a hard time getting pregnant when I tried,” she says, “so I thought, because I was older, it wouldn’t happen.” The father balked at having another child. Unwilling to risk breaking up her 15-year marriage to raise four children on her own, she had an abortion.

Her first son, at age 18, had also been a surprise. But dealing with an unplanned pregnancy at 33 turned out to be a vastly different world. “I had more people to think about,” she says. “I couldn’t just make a selfish, rash decision, which is what you do as a teen.”

Abortion remains among the most politically and emotionally divisive topics, and yet, much of the debate over women’s reproductive rights is underpinned by the notion that unplanned pregnancies are primarily a young woman’s issue. In fact, there has been a slow but profound shift in the demographics of both pregnancy and abortion. Between 1997 and 2005, the last year Statistics Canada reported on the subject, the abortion rate among teen girls fell nearly 30 per cent. It fell less dramatically among women in their 20s, who still represent the majority of abortions.

But when it comes to women in their 30s and 40s, the abortion rate—while still comparatively low—appears to be on the rise. By 2011, according to the Canadian Institute for Health Information, there were more abortions performed on women in their 30s and 40s than on teens.

“Most people, including many women themselves, mistake the notion that unplanned pregnancy is something that happens when you’re a teenager, that abortion is something teenagers deal with,” says Bill Albert, chief program officer for the National Campaign to Prevent Teen and Unplanned Pregnancy in the U.S., which is experiencing similar trends. “We have seen an extraordinary decline in teen pregnancies. We have not seen anywhere near the decline in unplanned pregnancies among women in their 20s and 30s.”

The shift in abortion demographics reflects the broader trend toward women delaying pregnancy. The average Canadian woman now has her first child at age 29, while the birth rate among women in their 40s has more than doubled in the past 20 years. Meanwhile, fewer teen girls are having abortions because fewer are getting pregnant in the first place.

Researchers are still struggling to understand what is behind the trend in unplanned pregnancies and abortions among older women. In the U.K., where the abortion rate among women over 30 has risen six per cent since 2001, the British Pregnancy Advisory Service points to the fact that many older women have stopped using contraception, because they assume they’re infertile after hearing stories of couples struggling to conceive through IVF and fertility experts warning of the risks to women who delay pregnancy. “We know from speaking to women that stories and campaigns suggesting it’s hard to get pregnant after 35 are having a real impact on women’s perception of their own fertility and, therefore, their use of contraception,” said chief executive Ann Furedi.

Nearly half the women having an abortion in their 40s that the agency has surveyed weren’t using any contraception, a rate much higher than teens and young women. American studies have found that among older women, those who are divorced or never married are less likely to use contraception, largely because some stop taking birth control pills when they’re not regularly sexually active, only to be unprepared when they start a new relationship.

Aging can also wreak havoc on women who primarily rely on natural birth control methods—such as timing intercourse around “safe periods” in their menstrual cycle—since cycles often become unpredictable after the age of 40. “They can have had a perfectly regular cycle and not had a single unplanned pregnancy in 15 years of marriage and then they hit 40 and their cycles change without them realizing it,” says Dr. Ellen Wiebe, medical director of Vancouver’s Willow Women’s Clinic, who co-authored a 2012 study on women having abortions over the age of 33. “They’re always really surprised, because they thought they knew their body well, and that they were old enough that it shouldn’t matter.”

Older women’s confusion over their own fertility is resulting in two seemingly contradictory trends when it comes to abortion: Some face the choice because they thought they were too old to get pregnant easily, while others make the choice because they are still struggling with the idea of becoming mothers at all. One 38-year-old told Wiebe and her colleagues that she was having an abortion, in part, because she didn’t want to start having children for at least two or three more years. “What I find so amazing is these women are ambivalent in their late 30s,” says Wiebe. “It was like, wait a minute, you’re getting close to your best-before date.”

Many know their fertility window is closing, but can’t see themselves raising children if they’re not in a stable relationship or financially independent, says Holly Yager, a Vancouver reproductive health and fertility counsellor and co-author of Wiebe’s study. “That comes up a lot, whether women have decided to get pregnant or to end a pregnancy: that at this age, I should be ready and my life should look like this,” says Yager. “There is just more pressure that they’re feeling, the expectation that they should be ready. And yet they’re not.” Even as close to a fifth of women go childless, that can make the decision to abort an unplanned pregnancy more fraught than for teens and younger women, who still have years to decide on motherhood.

But while it’s clear that women are choosing to start their families later, there is little hard data on what is driving the increase in abortions among older women in Canada, says Dr. Wendy Norman, a professor of family medicine at the University of British Columbia. (Not all provinces report detailed data on abortions, and the Public Health Agency of Canada’s survey of sexual health has so far only been given to those under the age of 25.) Norman’s research has found that roughly 31 per cent of Canadian women over 45 have had an abortion at some point in their lives. But researchers don’t know, for instance, how many unplanned pregnancies in women over 30 were because they were using contraceptive methods that have higher failure rates, such as the rhythm method, or because they have stopped using contraception altogether. The rising abortion rate may also be driven by women who are terminating planned pregnancies for medical reasons, such as fetal abnormalities, which are more common among older women.

All of which make it difficult for health care workers to try to address the underlying causes. “It’s very hard for us to understand what is happening with women in their 30s and 40s, who are seeking abortion at higher rates than previously, because we don’t have any national data collection on the factors that are going into the pregnancies,” Norman says.

That’s led to what some see as significant gaps in support services for older women who are dealing with unplanned pregnancies. For Carrie, the fact that she already knew the joys of motherhood made the decision to have an abortion particularly difficult. “I knew exactly what I was giving up,” she says. “I knew I was never going to get another chance.”

She also felt the staff at the abortion clinic assumed that because she was in her 30s and already had three children, she didn’t require counselling to help make the decision to end her pregnancy. Clinic staff told her abortion was likely her best option because of the complications with her past pregnancies.

Four years later, now 37, she’s still struggling with the emotional fallout. “[They] assumed I was old enough, mature enough to deal with it,” she says. “They were wrong. I very much needed help and was not given it. I think they focus on young girls and making sure they are okay with their decision. No one is doing the same for older women.”

The Bank of Canada released the latest batch of $10 polymer bills (Christinne Muschi / Reuters)

Good News

Courage under fire

A 29-year-old man is being hailed a hero after pulling a fellow passenger from the wreckage of a Bearskin Airlines plane that crashed en route to Red Lake, Ont., from Sioux Lookout, Ont. The man, whose name had not been released as of early this week, rescued a 50-year-old woman and called 911 just before the 19-seat turboprop plane burst into flames, killing both pilots and three other passengers. The cause of the crash is still unknown, but courage is alive and well.

Birth brains

Pregnant women who exercise for 20 minutes three times a week improve the brain function and capacity of their unborn children for life, according to Montreal researchers. They found that eight-day-old infants whose mothers had worked out often had brains as active as eight-month-old babies. Meanwhile, American researchers believe they have discovered the cause of sudden infant death syndrome. Abnormalities in the part of an infant’s brain stem that controls breathing, heart rate, temperature control and blood pressure may be to blame.

Cell phones for humanity

By 2019, more than 9.3 billion cellphones will be in use around the world, meaning mobile devices will be more accessible than clean water and toilets in some regions. That’s not necessarily a bad thing. As the New York Times recently noted, smartphone apps are increasingly being used to help people access education and health services, and participate politically—key precursors to eradicating poverty. Thanks to technology, the digital divide is narrowing fast, helping to solve some of the world’s most intractable problems in the process.

Fresh brew

Tim Hortons is finally introducing a cardboard sleeve for its coffee cups after years of forcing patrons to gingerly grip their piping-hot beverages with a thumb and forefinger. It’s also testing a new dark-roast blend—the first time it’s messed with its recipe in nearly 50 years. Purists will complain about the Starbucksification of a Canadian icon, but given the growing stakes in the $3-billion industry, including the successful rollout of McDonald’s McCafé two years ago, Tim Hortons is wise to sharpen its defence.

Bad News

Supreme confusion

The appointment of semi-retired Federal Court of Appeal judge Marc Nadon to the Supreme Court of Canada continues to create a constitutional mess. Nadon has been quarantined from his fellow justices after a Toronto lawyer challenged his eligibility, arguing that he was unable to fill one of three Quebec seats on the court because of his federal court background—a position Quebec has also taken. He was therefore absent this week when the country’s highest court heard arguments about Senate reform—a question that Quebec wants decided with a full bench.

Clicking train bombs

A 90-car train carrying oil from the Bakken shale deposit derailed in rural Alabama, sparking an inferno. No one was hurt, but the accident was eerily reminiscent of the derailment and explosion of the train that razed the Quebec town of Lac-Mégantic this summer, killing 47. As the North American oil industry increasingly turns to railroads to move crude, more needs to be done to prevent tanker cars from coming off the tracks—or, at the very least, making sure they don’t explode.

Deaf ears

Teenage education activist Malala Yousafzai’s recent tour of the West has made her an international celebrity. But it has yet to spark a change in her native Pakistan. Authorities there recently banned Yousafzai’s book I Am Malala from 40,000 school libraries, branding it a “tool for the West.” Some have even questioned the story behind her 2012 shooting at the hands of a Taliban gunman, suggesting it was staged by Western powers. One problem: Maulana Fazlullah, the new leader of the Pakistani Taliban, reportedly ordered the assassination attempt.

Start-smoking aids

Makers of e-cigarettes are marketing to children by using cartoon characters and fun flavours, the director of the U.S. Centers for Disease Control and Prevention told USA Today. The CDC says 10 per cent of U.S. middle and high school students tried smoking e-cigarettes in 2012, twice as many as a year earlier. A leading Canadian medical journal has raised similar concerns. E-cigarettes may be less harmful than real ones, but clearly, the best option is to avoid altogether getting kids hooked on nicotine.

She was at a sports centre for her charity SportsAid, and being an athlete herself, couldn’t resist taking to the volleyball court. She had to have known that her shirt was going to ride up as she reached to hit the ball, yet clearly she didn’t care. And why should she? Just three months after giving birth, she’s got an enviable post-pregnancy body. And that she showed it off at a public engagement while wearing casual clothes, not by posting an oh-so-deliberately posed picture, means that in this war of the yummy mummies, it’s Kate 1, Kim 0. (And Kate gets bonus points for hitting the court in towering wedges.)

]]>For those who missed it, the duchess of Cambridge delivered an 8 lb., 6 oz. baby boy on Monday following a 10-hour labour. The next day, she was thrust before a public throng hungry for a glimpse of the newborn prince. During the brief appearance, the new mother appeared healthy, radiant and preternaturally relaxed—glowing and seemingly well-rested. Yet one detail of her appearance seemed to confound the public, particularly young women and men. As Kate cupped her hand over her billowy dress, it was evident that her belly—one that only hours earlier had produced another human being—was still convex. Social media went ballistic—”Sky News asking why Kate still has a bump,” one tweet read; “Kate still got her baby bump #fatbitch” read one from a man. Another woman attempted to be slightly more humane: “We all love kate. I’m just saying she looks better without the bump #fact.”

Such ignorance about what a healthy post-partum body looks like (see here for a primer on “mommy tummy”) offers a sad commentary on the glamorized, sanitized, utterly unrealistic imagery surrounding pregnancy in our culture, particularly in gestation-obsessed celebrity tabloids. Within that oppressive genre, snark is ladled out equally for women seen to gain too much weight while pregnant — or too little, a charge levied at Kate by the British press. Women themselves routinely report disgust with feeling “fat” while pregnant: “How the f#@k did I get like this,” a somewhat pregnant Kim Kardashian whined on her reality show; recently, the actress Selma Hayek, who gained 50 pounds while pregnant with her daughter, said carrying a child made her feel “completely disfigured.” The picture is further distorted by celebrities who return to their pre-baby body in record time—either by having a stealth tummy tuck after an elective Caesarian or by following regimens that would have exhausted the Spartans: the actress Kate Hudson, for one, admitted she worked out six hours a day to get back into shape.

Already Kate’s post-partum silhouette has heightened awareness of the reality gap. A theory has been floated that the fleeting sight of her belly “busts the last taboo of pregnancy” — that it was a historical event, a political statement in solidarity with new moms everywhere. Other outlets have suggested the empire-waisted Jenny Packham dress she wore was strategically chosen to do just that. And we’ve seen fury expressed over the coverline on OK magazine’s “Royal Baby Special,” which offered the inside scoop on “Kate’s post-baby weight-loss regime.” Outraged readers called for a boycott of the magazine, which in turn was compelled to issue an apology. It’s a start. Whether the royal sea change will trickle down to celebrity-obsessed commoners remains to be seen.

]]>http://www.macleans.ca/news/world/kate-vanquishes-baby-bump-police/feed/53Tweeting the Great Kate Waithttp://www.macleans.ca/authors/patricia-treble/tweeting-the-great-kate-wait/
http://www.macleans.ca/authors/patricia-treble/tweeting-the-great-kate-wait/#commentsMon, 22 Jul 2013 15:45:17 +0000http://www2.macleans.ca/?p=406958While cynics do their best to pretend to ignore the royal birth, the rest of the twittersphere erupts.
The first person to tweet the news was freelance photographer Jesal Parshotam,…

All the bigwigs got in on the act, including grandpa-to-be Prince Charles—in the dark like all of us— as well as PM David Cameron and the archbishop of Canterbury, Justin Welby (the baby will one day be supreme governor of the Church of England).

The Great Kate Wait is nearly over. She was admitted to hospital early this morning. It appears Kate, duchess of Cambridge, went into labour naturally. Once safely inside St. Mary’s Hospital, royal officials told the world:

The Duchess of Cambridge has been admitted to St Mary’s Hospital in the early stages of labour

Published on 22nd July 2013

Her Royal Highness The Duchess of Cambridge has been admitted to St. Mary’s Hospital, Paddington, London in the early stages of labour.

The Duchess travelled by car from Kensington Palace to the Lindo Wing at St. Mary’s Hospital with The Duke of Cambridge.

Kate and William’s arrival occurred so early in the morning that most of the media who have camped outside St. Mary’s Hospital were tucked in bed. Not any more:

So now, after three weeks of no information, comes hours of even more of the same. Citizens won’t know anything until a royal courier leaves the hospital with the big news, which will be taken to Buckingham Palace to be placed on an easel in the forecourt so the world can finally know the sex, weight and time of arrival of the future monarch.

Until then, royal watchers will have some waiting to do while the duchess is in labour.

Here is a look at the royal baby-to-be, by numbers:

2 – Number of years the Duke and Duchess of Cambridge were married before the birth of their baby.
3 – William and Kate’s baby will be born third in line to the throne and the Queen’s third great-grandchild.
4 – The baby will bump Prince Harry down to fourth in line to the throne.
5 – William and Kate’s first-born will be the great-great-great-great-great-grandchild (five greats) of Queen Victoria.
16 – The baby will one day be head of state of 16 countries.
31 – William and Kate will both be 31 when the baby is born.
41 – Royal births are celebrated with a 41-gun salute.
43 – If the baby follows the Prince of Wales and William on to the throne, he or she will be the 43rd monarch since William the Conqueror in 1066.
£6,265 – Cost of a one-night stay and delivery package at the private Lindo wing including a suite of two rooms, but excluding consultants’ fees.
£19 million – The yearly income from the Duchy of Cornwall landed estate – which, when one day the baby becomes the heir apparent, will be used as its private funding.
Two billion – The baby may one day be head of the Commonwealth, which covers 54 nations and two billion citizens.

]]>http://www.macleans.ca/authors/patricia-treble/kates-in-labour-in-hospital-official/feed/4Poll: When is the new royal prince or princess arriving?http://www.macleans.ca/authors/patricia-treble/poll-when-is-the-new-royal-prince-or-princess-arriving/
http://www.macleans.ca/authors/patricia-treble/poll-when-is-the-new-royal-prince-or-princess-arriving/#commentsMon, 08 Jul 2013 18:20:16 +0000http://www2.macleans.ca/?p=402916All eyes are on Kate, duchess of Cambridge

The media is camped outside St. Mary’s Hospital in London. Those not sleeping there overnight are obsessively checking smartphones for the slightest hint that Kate, duchess of Cambridge, may be, possibly, going into labour.

Reportedly, there are detailed plans to get the princely father-to-be from his job as a search-and-rescue pilot in Wales to London in time.

And this morning came word that another great-grandchild is on the way. Zara Phillips, Princess Anne’s daughter who won silver at the London Olympics, announced that she and her husband, rugby star Mike Tindall, are having a baby in the New Year.

For now, there is nothing to do but obsess about trivia, such as the exact nomenclature of the new baby’s title. First the backstory: Earlier this year everyone realized that, unless Her Majesty did something, the third-generation heir wouldn’t be a prince or princess, but the child of a duke. So Elizabeth II changed the rules to upgrade the title of her third great-grandchild in this official notice:

The Queen has been pleased by Letters Patent under the Great Seal of the Realm dated 31 December 2012 to declare that all the children of the eldest son of The Prince of Wales should have and enjoy the style, title and attribute of Royal Highness with the titular dignity of Prince or Princess prefixed to their Christian names or with such other titles of honour.

While the title change became public in January, now everyone has oh-so-much time on their hands that they have the luxury of delving into an extended worry session about whether there’s a “the” in front of the name or not. (According to expert Joe Little of Majesty, the answer is no.)

Given everyone is just waiting and watching, the only thing left to do is launch a poll on when you think the royal baby will make his or her grand appearance. You can take a flutter on an auspicious day — July 14 is Bastille Day in France — or throw a dart at a date. For the curious, betting firm William Hill has calculated the odds of when it thinks the baby will born.

]]>http://www.macleans.ca/authors/patricia-treble/poll-when-is-the-new-royal-prince-or-princess-arriving/feed/2The craze around the royal birthhttp://www.macleans.ca/authors/patricia-treble/the-craze-around-the-royal-birth/
http://www.macleans.ca/authors/patricia-treble/the-craze-around-the-royal-birth/#commentsThu, 04 Jul 2013 21:09:57 +0000http://www2.macleans.ca/?p=402154...or 'Event SO601865', as London police are calling it

Photographers and television crews mark out positions in front of the door to the Lindo Wing of St Mary's Hospital, where Britain's Catherine, Duchess of Cambridge is due to give birth in central London. (Neil Hall/Reuters)

Starting this week, media began camping outside St. Mary’s Hospital in London in anticipation of the birth of the future monarch of Britain (and Canada and 14 other realms).

It sounds kind of unbelievable that news organizations are scheduling around the clock coverage of a hospital, but this is an event with no known schedule other than the knowledge that Kate has to go to hospital, sooner or later. No one wants to be the only organization that wasn’t there to cover it. With all the world watching, the birth is big business for all concerned.

As Sky News royal correspondent Paul Harrison (@skynewsroyal) tweeted: “I’m sleeping badly. Off the booze. Mobile off silent. Bag packed. Hospital route planned. And it’s not even my baby!!” It’s such a large production that London’s Metropolitan Police have given the birth its own code. So while most might call it “William and Kate have a baby,” it’s Event SO601865 for the bobbies and other police officers outside the hospital, where parking is suspended from July 1 to July 31.

The birth of the future king or queen is Scotland Yard’s event no. SO601865 according to sign outside hosp pic.twitter.com/2uLCxnpwIC

And don’t think it’s just the media that has drunk deeply from a royal chalice. William Hill, one of Britain’s biggest betting shops, is taking odds on everything from the baby’s weight (6 lb. to 6 lb. 15 oz. is 7:2), the birth date (July 30 is 40:1), the day of the week (Monday is 11:2) and of course the name (Chardonnay is 250:1, for those wanting long odds). The stores are filled with tchotchkes. And the Royal Mint, always eager to capitalize on any Windsor happening, is giving away up to 2,013 “lucky” pennies for babies born on the same day (everyone else can plunk down $40 for one), complete with its own pink or blue bag.

It’s gotten so nutty that Gordon Rayner, the chief reporter at the Daily Telegraph, is getting mail using a new infant-focused title.

]]>Charlotte Casiraghi, the 26-year-old daughter of Princess Caroline of Monaco, appears to be carrying on a royal family tradition—of becoming pregnant before the wedding. Reports say that Charlotte, fourth in line to the throne, is having a baby with her 41-year-old boyfriend. The rumours started this weekend when she was seen at several equestrian events, not as a participant, but as a trophy presenter. And one wearing suddenly wearing loose clothes and displaying what appears to be a baby bump on her normally washboard-flat stomach. Apparently she hasn’t competed since early April.

If the pregnancy is confirmed, it won’t shock conservative Monaco. As the Unofficially Royal site states, “Of the nine grandchildren of Prince Rainier III and Princess Grace, only two (the two youngest Casiraghi children) were conceived during a marriage.” And Charlotte’s older brother, Andrea, number two in line to the throne behind mom Caroline, just had a baby with his heiress fiancée, Tatiana Santo Domingo, who was with Charlotte in Paris.

If this sounds tremendously old-fashioned in a world in which more and more couples aren’t getting married, well, royal families are, by their nature, conservative. They have to be seen as legitimate to claim the throne. And that means marriage, or retroactive legitimization if all else fails (see below). Just look at the scandal that gripped Luxembourg when Prince Louis, then 19, got his girlfriend pregnant. It’s doubly important in Monaco because the head of the family, Uncle Albert II, the present head of Monaco, has no children—well, no legitimate children.As I wrote in 2011:

Albert, a lifelong bachelor, confessed, mere weeks after his father died in 2005 and he’d assumed power, that he’d fathered a boy, Alexandre, then three, with a Togolese flight attendant. The revelation at least put to rest the rumours that he was gay, which had dogged him for years. He hinted on French TV that there were other progeny. “I know there are other people who are in more or less the same situation. We will give them an answer at the appropriate time.” Then, in 2006, he acknowledged his 14-year-old daughter, Jazmin Grace, the result of a vacation fling in 1991 with a married Californian, Tamara Rotolo. Neither illegitimate child can inherit the throne.

If his wife, Charlene, doesn’t have a child—and given her often-unhappy visage when out with Albert, there’s not a lot of hope of that happening—then the future of Monaco’s royal family will be in the hands of Caroline and her Casiraghi children. So Andrea’s (and perhaps Charlotte’s) out-of-wedlock progeny will have to be legitimized if the royal line is to survive.

In 1922 the Grimaldis faced a succession crisis far more dire than what they’re confronting now. At that time Monaco’s ruling family consisted of only two members: Prince Albert l and his aging, terminal bachelor son, Hereditary Prince Louis. Per Monaco’s 1912 treaty with France, the principality would lose its sovereignty and become part of the French Republic if all legitimate members of the ruling family were to die out. Although the existence of Prince Albert’s German cousin, Wilhelm, 2nd Duke of Urach, would’ve prevented this from happening, Albert preferred that the Monegasque throne remain in his immediate family. This obligated him to allow Louis to formally adopt and legitimate his only acknowledged bastard: a daughter named Charlotte Louvet.

So good luck Charlotte! Hopefully you’ll escape the other Grimaldi tradition of multiple marriages, most of them deeply unhappy.

]]>http://www.macleans.ca/authors/patricia-treble/does-monacos-royal-family-have-a-legitimacy-issue/feed/5In-laws in the delivery roomhttp://www.macleans.ca/society/life/make-way-for-the-labour-crashers/
http://www.macleans.ca/society/life/make-way-for-the-labour-crashers/#commentsSat, 08 Jun 2013 11:00:00 +0000http://www2.macleans.ca/?p=391784Modern-day parenting question: How many is too many in the birthing tub?

When Emmanuel Morin’s wife, Sheryne, went into labour for their daughter’s birth a few years ago, the couple was far from alone. Crowding the small Ottawa delivery room were “both sets of grandparents, both sets of siblings—and their boyfriends, girlfriends and spouses—plus Sheryne’s cousins,” the 32-year-old Ottawa consultant explains. More than a dozen family members came out to support them. “Sheryne’s father wasn’t even there for her birth,” Emmanuel chuckles, adding that his dad missed his birth, too. But both were determined to witness their granddaughter’s first breaths. (Sheryne’s father paced throughout and required multiple cigarette breaks; the stress of seeing his daughter in such agonizing pain was clearly tough to handle.)

Just a generation ago, dads had to fight their way into delivery rooms in Canada. But over the past decade, the pendulum has swung in the opposite direction, expanding birthing support circles to include mothers, sisters, in-laws and best friends. For some families, birth is becoming a shared rite, like weddings and graduations—albeit one requiring a whole new level of trust and intimacy.

Sheryne was naked in a birthing tub. Emmanuel, who’d climbed in with her, was scooping membranes and mucus from the water while his brother-in-law filmed from above, chronicling the scene. Staff at Ottawa’s Monfort Hospital brought in extra chairs to accommodate them all. Their family was largely well-behaved, says Emmanuel, though some, toward the end, did start second-guessing decisions made by the midwife or the doula.

Hospital policies are changing rapidly to accommodate birth’s newly inclusive approach. B.C. Women’s Hospital, on Vancouver’s West Side, actively encourages the participation of family and friends, allowing larger groups for low-risk births. And some new hospitals and birthing centres are even designing “family zones,” with added space near the mother’s head, allowing for large groups—though others, such as Calgary’s three urban hospitals, limit the numbers of visitors to two.

But as delivery rooms become less sacrosanct, some new parents are being pressured to extend invites to friends and family, giving rise to a new category of unwanted guest: the labour crasher. Indeed, on parenting websites, some of the most popular threads involve trading tips on keeping uninvited relatives out of the delivery room. On the parenting website BabyCenter, one woman recounted how her (uninvited) mother-in-law was discovered hiding in the delivery-room bathroom. Another recalled hers barging in to her C-section prep; somehow, she ended up holding the baby before the baby’s mother did. Another had to ask her mother to exit the birthing suite. She threw a fit and screamed hurtful things before storming out, leaving mom-to-be in tears just as she began pushing. And when one woman began crowning, her doctor let her reach down to touch the baby’s head. Her mother-in-law happily shrieked, “My turn!” and reached to feel for herself until the doctor managed to block her hand.

Winnipeg midwife Julia Allen has had to ask mothers-in-law or close friends to wait in the cafeteria for a few minutes, telling them mom needs her privacy. But these are rare exceptions, says Allen. She thinks the opening of the delivery room is a “fabulous” development, and always counsels patients to bring more than just their spouses for support. “Thirty-six hours of labour is too much for one person to handle alone,” she says.

Winnipeg’s Lauren MacMillan is thankful she chose to include her mom when she gave birth to her son six months ago. Initially, Lauren’s wife, Dayna, wanted the birth to be an intimate moment between them. They didn’t ask Lauren’s mom, Cheryl, until they arrived at Winnipeg’s Health Sciences Centre, when Lauren was in labour. In the end, having her in the room “didn’t take anything at all away from the experience,” says Lauren; in fact, it made it all the sweeter. Emmanuel Morin agrees. His daughter entered the world surrounded by the people who love her the most; everyone in the room had the chance to hold her in her first 30 minutes. “It was an unforgettable experience,” he says—for all involved.

That everything Kate, duchess of Cambridge, wears is an instant retail hit has been such a long-proved commercial reality that it’s got its own moniker, the “Kate effect.”

Witness what happened the moment she appeared on Friday at the Warner Bros. studios wearing a polka dot dress from Topshop. It sold out instantly. It’s happened again and again.

Now the fairy dust that rubs off on everything Kate touches is doing more than just boost corporate profits. It’s benefitting charities as well.Organizations lucky to have her as a patron report big increases in interest.

Five blogs that follow Kate are on a charitable fundraising mission, starting on Monday, Apr. 29. In anticipation of the birth of William and Kate’s baby in mid July, they’re asking readers to contribute to EACH, the East Anglia’s Children’s Hospices, that support families dealing with life-threatening childhood ailments at three hospice locations in England. Kate has been its patron since January 2012. To deliver its needed services, EACH, which approves of the blog charitable drive, has to raise $9 million each year from the public.

It was Dash, the power behind the British Royals blog, who had the initial idea for a fundraiser to commemorate the new baby. She reached out to four other bloggers and soon their plan was in motion. Together they are the best of the best when it comes to keeping up with Kate’s activities and fashions. Together, these five blogs–British Royals, Duchess Kate, Kate Middleton Style, What Kate Wore, A Petite Princess are seen by 250,000 unique readers each week.

“When the five of us got to talking about which of Kate’s charities to select as a beneficiary,” Susan Kelley of What Kate Wore says, “EACH just seemed to come up again and again. Kate seems to have a special affinity to the children’s hospice issue and EACH in particular.”

Yet this isn’t just a “please donate” plea that most casual readers would ignore. These bloggers are serious about this campaign and its goals. Susan Kelley says that they want thousands of dollars, pounds, euros etc to pour into EACH’s kitty. And they’re also very sophisticated about how to harness the power of social media. And that means courting readers (and their wallets.) So they’ve gathered donations from many of the fashion designers who have benefited by having Kate wear their items. From Monday, Apr. 29 through Aug. 31, readers will be able to win desirable offerings from the likes of Links of London, London Sole and Temperley London in online auctions and random drawings.

If giving isn’t enough, then consider volunteering. Lots are. The Scouts in Britain have witnessed an explosion of interest since Kate volunteered to be a leader of the local Cub group in Wales, where she lives with her husband, whose RAF search-and-rescue squadron is based. According to the Telegraph, membership has jumped by 11,400 in a year while more than 2,800 adults have signed up as volunteers–an increase the organization directly attributed to the duchess’s example. Kate, who was a Brownie herself, is part of an army of so-called flexible volunteers, who offer services when they’ve got free time, rather than at a strictly set time. The Scouts expect the influx of new volunteers to help winnow down the 35,000 children on waiting lists because of lack of adult organizers.

The focus on charity and volunteering is one Kate effect that everyone can truly get behind.

Last December, the Supreme Court of British Columbia set a bold precedent: it green-lit the first class action suit in Canada alleging that an antidepressant taken by a woman during pregnancy caused a birth defect in her child. Faith Gibson of Surrey, B.C., named “representative plaintiff,” had been prescribed Paxil, a selective serotonin reuptake inhibitor (SSRI), in December 2002. Her daughter, Meah Bartram, was born in September 2005 with a hole in her heart. The defect was repaired months later, but Meah remains a “sickly” child, prone to infection. Two weeks after her birth, Health Canada and Paxil’s manufacturer, GlaxoSmithKline Inc. (GSK), issued an advisory stating that paroxetine (Paxil’s generic name) taken in the first trimester may pose “an increased risk” of cardiovascular defects.

Gibson’s lawyers allege GSK knew or should have known about the risks and that it failed to apprise Gibson or her physicians. Gibson had asked her doctor if she should go off the drug during pregnancy; she was told it was “100 per cent safe.” More than two dozen women have applied to be screened for class membership since December, says Vancouver lawyer David Rosenberg, who is representing Gibson.

GSK has appealed the decision to register the case as a class action; it contends it acted appropriately in its clinical trials, as well as in the safety monitoring and marketing of Paxil, updating pregnancy information as data became available, spokeswoman Michelle Smolenaars Hunter told Maclean’s.

Legal wrangling over Bartram vs. GlaxoSmithKline is destined to play out for years. But already the case has put a spotlight on a controversial yet surprisingly little discussed subject: the rising use of SSRIs during pregnancy. This is despite the fact that animal studies dating to the early ’80s linked SSRIs with increased risk of birth defects, and that SSRIs—which are believed to ease depression by blocking the reabsorption of the neurotransmitter serotonin in the brain—are not approved for use in pregnancy, except where “the potential benefit outweighs the potential risk,” to quote one Canadian label warning.

More than 2,500 lawsuits linking birth defects to use of SSRIs, a category that includes Zoloft and Prozac, have been launched in the U.S. (the only one to reach verdict at trial, Kilker vs. GSK, in 2009, ruled for the plaintiff). Many cases are settled out of court (in 2010, Bloomberg News reported GSK agreed to pay more than $1 billion to resolve more than 800 birth defect cases). Regulators have also issued further warnings. One, from the U.S. Food and Drug Administration in 2005 downgraded Paxil from a C rating (“potential benefits may warrant use of the drug in pregnant women despite potential risks”) to D (“positive evidence of human fetal risk”).

Yet, despite rising cautions regarding risks, SSRIs have become the top-prescribed drugs in pregnancy, surpassing those for diabetes or nausea, says Anick Bérard, director of the medications and pregnancy unit at Ste-Justine University Hospital and a professor at the pharmacy faculty of the Université de Montréal. And their use is on the rise. Bérard estimates 12 to 15 per cent of expectant women take SSRIs, even though short- and long-term risks aren’t known; for ethical reasons, pregnant women are not allowed to participate in the randomized, controlled clinical trials that would reveal such risks. But Bérard points to significant epidemiological, or population, studies that outline the relationship between SSRI use and a small but decided risk of miscarriage and stillbirth, persistent pulmonary hypertension and heart defects in newborns, as well as neonatal withdrawal syndrome. Data from animal and human studies also raise serious concerns that exposure to SSRIs during pregnancy damages the developing brain and may cause neurodevelopmental abnormalities, including autism.

Complicating matters is the fact that research in the field is wildly conflicting and riven with conflicts of interest. A 2006 Journal of the American Medical Association (JAMA)study, for instance, found that women who stopped taking SSRIs when pregnant were far more likely to relapse into depression; the report stoked controversy when it was revealed all of the 13 authors had failed to disclose drug-company funding. The same data can sometimes even yield divergent conclusions. Take two studies based on 1.6 million infants born in five Nordic countries between 1996 and 2007: one, in the British Medical Journal in 2012, concluded that potentially fatal persistent pulmonary hypertension in newborns more than doubled with mothers’ SSRI use in late pregnancy. But a 2013 JAMA study reported SSRIs pose no infant mortality risk.

The spectre of pregnant women being prescribed drugs that alter brain chemistry—and come with serious side effects, including suicide risk—might seem incongruous in a culture in which expectant women are told to avoid soft cheeses, alcohol, even Aspirin. What has paved the way, however, is research sounding alarms about the even greater risks posed by clinical depression during pregnancy. And at the forefront of that research is the world’s largest and most trusted source on the safety of drugs, toxins and chemicals on pregnancy and lactation: the Motherisk program at Toronto’s world-renowned Hospital for Sick Children—and the unit’s high-profile director, Gideon Koren.

Since its founding in 1985, Motherisk has consulted with more than 250,000 women in its clinic and on phone lines, and answered their questions about the safety of drugs, chemicals and toxins in pregnancy. It also conducts its own research, which includes tracking pregnant women, though it doesn’t stage randomized drug safety trials. Over the years, Motherisk has produced 92 papers on depression. It has consistently asserted that depression during pregnancy poses greater risks to mother and unborn child than SSRIs. Untreated depression, it warns, can lead to habits—alcohol and drug abuse, smoking, poor nutrition—that compromise fetal development. It also links stress hormones, or cortisol, with premature birth, lower birth weight, gestational hypertension and pre-eclampsia.

The centre has vocally dismissed regulator warnings about SSRIs, including Health Canada’s 2005 Paxil advisory, which Motherisk claimed was “based on small non-peer review, unpublished studies.” It also noted that no association with a higher risk of congenital malformations has been shown for SSRIs as a class. A 2010 Motherisk report found no increased risk of neonatal heart defects with maternal paroxetine use; in reports published in 2011 and 2012 they ascribed the higher number of cardiac malformations seen in unborn children of depressed women who took SSRIs to “ascertainment bias”—the fact anxious and depressed women are more likely to have the scans that identify them. Motherisk reassured women in 2005 that “beyond the first trimester, a drug cannot cause cardiac malformation,” and a 2006 Motherisk report notes many cardiac malformations “resolve spontaneously.”

SSRI risks in pregnancy are “small” next to those posed by clinical depression, Motherisk reports conclude repeatedly. A 2012 study states that for women diagnosed with the condition, “the benefits of [SSRI] therapy far outweigh the potential minimal risks.” It wants to see all pregnant women screened for depression, even those without symptoms or a history. The message is clear: by taking SSRIs during pregnancy, a depressed woman can protect both herself and her unborn child.

And it’s heard by a huge audience. Motherisk is the first port of call for doctors and patients alike; it influences clinical practice at home and abroad. When the duchess of Cambridge was hospitalized for severe nausea, Koren was the media go-to. Motherisk’s research is also used by pharmaceutical companies to defend birth defect cases, says Sean Tracey, the Houston lawyer who prevailed in Kilker vs. GSK.

Yet a rising chorus of researchers is questioning Motherisk’s stance on SSRI use in pregnancy. One of the most vocal is psychiatrist and psychopharmacologist David Healy, director of the North Wales department of psychological medicine at Cardiff University. Healy, who prescribes SSRIs selectively, says there’s no good data suggesting untreated depression is more dangerous to mother and child than SSRIs.

And the damage done by SSRI use, he says, may actually be worse than the numbers suggest. Studies have also linked SSRI use in pregnancy to higher “voluntary terminations,” or abortions, he says, prompted in part by birth defects detected in prenatal scanning. Clinical depression in pregnancy is a serious concern, Healy told Maclean’s. “But effective treatments exist that are less risky for the fetus.” In his 2012 book Pharmageddon, Healy identifies rising SSRI use in pregnancy as the most ominous portend of the grip Big Pharma now exerts over medicine.

When Heidi Murkoff published the first edition of What to Expect When You’re Expecting?in 1984, 2½ pages were devoted to postnatal depression. The book’s current and fourth edition allots more than seven pages to depression—from pre-pregnancy, through the newly coined “antepartum” to postnatal—plus two pages to antidepressants. The intervening three decades have seen a 180-degree turn from the gauzy view that pregnancy’s flood of happy hormones protects women from depression, to warnings that pregnancy itself is a trigger. By the time Murkoff’s book was made into a very bad film in 2012, the stressed-out, combustible pregnant woman was a stock character. “Well, I’m calling it!” a woman in the movie rants, “Pregnancy sucks! Making another human being is really hard! I have no control over my body or my emotions!” That view is now so engrained that when Yahoo! CEO Marissa Mayer reported she had “a really easy, healthy pregnancy” last year, she was accused of lying.

Pregnancy’s emergence as a new frontier for female depression can be seen as a continuation of a broader cultural theme dating to “hysteria” in antiquity: the notion that female reproductive function predisposes one to irrationality and anxiety. According to a 2011 Centers for Disease Control (CDC) study, 10 per cent of women between 18 and 39 are on antidepressants, with women far more likely than men to be prescribed them. Anti-anxiety and antidepressant medications are now even emerging as the 21st century’s “mother’s little helper,” the nickname Valium was given in the ’60s. Last month, an ABC News story titled “Moms on Xanax: women say antidepressants, anti-anxiety meds make them better moms,” quoted an upcoming study in the medical journal Pediatricsthat suggests as many as one in five new mothers suffers from “heightened anxiety” in the weeks and months after childbirth. One woman, Melissa Sanchez, told Good Morning Americashe was prescribed the SSRI Celexa after she “psychically collapsed” after her son’s birth. She reported she “has no doubt that her anti-anxiety drug made her a better mother.”

No one disputes that depression during or after pregnancy is real, but the presumption that all pregnant women may be at risk reflects a real shift. Drug companies have successfully capitalized on this theme by aggressively targeting women of child-bearing years. Evidence presented at U.S. birth defect trials reveals the extent of this marketing, which includes planting “ghostwritten” studies (reports generated by drug companies who pay prominent researchers to put their names on them and then publish them in respected medical journals—an unethical but common practice). In 2000, GSK launched a “Mother knows best” campaign to market Paxil; it planned to make it “the drug of choice for women.”

The strategy appears to have worked. Filings in the Canadian Paxil class action show nearly six million Paxil prescriptions were written between 1993 and 2009 to Canadian women of child-bearing age. Being prescribed an SSRI can put women on a treadmill, says Barbara Mintzes, an assistant professor in the department of pharmacology and therapeutics at the University of British Columbia who has studied the pharmaceutical industry’s effect on public health for 20 years: “Many who become pregnant are told to stay on the drugs, even if they don’t have depression symptoms, out of fear of a recurrence.” Healy cites another concern: “Women often aren’t told about addiction risks or the difficulty of withdrawal, which creates problems if they become pregnant.”

Hayley Wine, a 41-year-old Toronto mother of three who has taken antidepressants since she was diagnosed with clinical depression at age 16, reports a sea change in attitudes over the past decade. When she was pregnant with her first child in 2004, she stopped taking medication for fear of fetal harm. She did the same for her second pregnancy, but became depressed, so her doctor told her to go back on. She consulted with Motherisk and was told risks arising from depression were greater. She didn’t stop taking the drugs for her third pregnancy, which had complications, she says. She’s now been told her baby will experience neonatal withdrawal when she stops nursing. “So many moms I speak to now don’t go off their meds,” she says, noting some were prescribed SSRIs by GPs to treat migraines.

That’s not surprising. A 2005 study, “The marketization of depression: The prescribing of SSRI antidepressants to women,” by Janet Currie for the group Women and Health Protection, notes nearly four-fifths of prescriptions for antidepressants are written by GPs; the CDC reports that less than one-third of people on antidepressants see a mental health professional, which means most are prescribed without a clinical depression diagnosis by a specialist. Healy is not alone in noting SSRIs are based on an unproven hypothesis that has become medical orthodoxy: that depressed people have lower serotonin levels. “It creates the perception that leaving depression untreated is like leaving tuberculosis untreated,” he says.

On Motherisk.org,depression is listed with tuberculosis, asthma and epilepsy, and is described as a “chronic condition,” and warns that “puberty marks the beginning of the increased risk for depression in women.” All women visiting the centre are asked to fill out the Edinburgh postnatal depression scale, which gauges their mood over the previous seven days. Motherisk doesn’t diagnose depression, but puts screening results in a woman’s file for her doctor. That women going through a huge, hormonally driven life change would answer in the affirmative to some of the test’s 10 questions—“I have been anxious or worried for no good reason,” and, “Things have been getting on top of me”—isn’t surprising. A score of 10 or more, which would be easy to reach, indicates “possible depression.”

Screening for depression generally—not only in pregnancy—is a controversial topic. A 2011 Canadian Medical Association Journalanalysis called general screening “a resource-intensive endeavour, [which] does not yet show evidence of benefit and would have unintended negative effects for some patients.” In the 2009 Journal of Affective Disorders study, “Are we over-pathologizing motherhood?” Stephen Matthey, a psychologist then at the University of Sydney, assessed the Edinburgh scale to conclude, “around 50 per cent of women scoring high are not in fact depressed.” Many of the diagnostic criteria for depression—weight loss, sleep problems, fatigue—can as easily be attributed to new parenthood, Matthey writes.

They may also be a product of socioeconomic pressures. Assuming that maternal depression is what poses risk to the fetus is blinkered, says Françoise Baylis, the Canada Research chair in bioethics and philosophy at Dalhousie University: “Does [maternal] depression lead to these harms or does it have more to do with other factors such as poverty and lack of social support?” she asks.

Given most women don’t see a psychiatrist after screening, and that Motherisk carries so much weight with doctors, critics feel there is a real chance of women going on drugs with not much more than a single questionnaire.

Mintzes also expresses concern that widespread screening “will normalize the idea that pregnancy is a high-risk experience for the psychiatric condition of depression, which it’s not.” It’s “a recipe for finding false positives,” she says, which could lump women with no or mild depression with those with major depression: “Given research indicating SSRIs are no more effective than placebos for mild depression, this could put unborn children at needless risk.”

Bérard questions the value of screening without providing treatment services: “Screening to do what?” she asks. “To give pregnant women antidepressants?” She too is leery of Motherisk’s claim that untreated depression is more harmful to an unborn child than an SSRI. It isn’t supported by any evidence she has seen, outside of Motherisk’s, she says—“And I look at the literature day in, day out.”

One criticism that observers like Mintzes make is that Motherisk receives some funding from drug companies, though exactly how much is hard to discern. Industry funds fuel much medical research, but Motherisk’s role counselling pregnant women raises heightened concerns about potential bias.

That concern doesn’t just apply to questions about SSRIs. Women wanting information on morning sickness, for instance, can call a toll-free Motherisk “morning sickness helpline”—which is “partly sponsored by” Duchesnay, a Blainville, Que., company that makes Diclectin, the only prescription drug in Canada for nausea and vomiting in pregnancy. Diclectin is a generic version of Bendectin, a drug removed voluntarily from the U.S. market in 1983 by Merrell Dow after it was subject to hundreds of birth defect lawsuits, none successful. The controversy surrounding the drug isn’t mentioned on Motherisk’s website. Motherisk.org also recruits advertising, calling itself “a prime online venue for corporate sponsors”; it sells “sponsor tiles” with space for a company’s name, location and a “value-neutral description of products” for $1,500 a month.

Alan Cassels, a drug policy expert affiliated with the University of Victoria, has questioned the objectivity of Motherisk’s research, writing that it is “obviously drug tainted.” And Mintzes says any organization providing advice to pregnant women and their health care providers should be completely independent of the manufacturers of the products they are discussing. “Pregnancy is a time women require more protection, not less,” she says. She would like Motherisk to refer to SSRI risks cited in other studies and to also list Health Canada warnings, so women can judge for themselves: “Its message is consistently one of dismissing potential harm of SSRIs and a fairly unnuanced approach to depression treatment in pregnancy,” she says.

A schism has grown between the scientific research community’s view of Motherisk’s SSRI research and the public’s faith in it, Bérard says: “Motherisk is losing ground in terms of credibility and impact. But in the lay public area, the reason why they’re still out there—they’re very vocal and high-profile. They make good news—and nobody bothers to check anything.”

Sitting in his eighth-floor office, surrounded by teddy bears used in Sick Kids’ “Bear Theatre” Christmas fundraiser, Gideon Koren appears an affable, grandfatherly advocate for maternal and childhood health. “Life begins before birth,” he says. The well-connected MD wields considerable influence. Koren lectures internationally, sits on myriad boards—among them scientific journals and drug companies—and is a prolific researcher known for forging alliances between industry and the hospital. “ ‘Gidi’ is Sick Kids’s clinical-trial rainmaker,” a former colleague says. His CV, which tops 150 pages, is laden with honours and awards. In practice for four decades—three of them at Sick Kids, 28 years running Motherisk—Koren has also generated controversy. People may remember him as the doctor who wrote anonymous poison-pen letters about his former research partner Nancy Olivieri in the infamous Apotex scandal of the late ’90s.

Koren speaks with the genial paternal authority of someone who runs a maternal-research authority with a staff of 71. Depression screening in pregnancy is vital, he says: “Many women don’t even know they’re depressed.” Over-diagnosis simply “means the test is working.” Ideally, a woman who scores high will then see a psychiatrist, though that doesn’t always happen, Koren admits.

Inappropriate prescribing is a worry, he says: “There’s an immense drive to tell consumers that drugs solve everything.” But he’s more concerned about SSRI risks being exaggerated. His 2012 report, “Depression in pregnancy: time to stop terrifying pregnant women,” blasts researchers who “continue to terrify women who are at serious life-threatening risk if not treated pharmacologically.” Koren waves off his critics: “There is a lot of quackery going on,” he says. “Most of these epidemiologists have not seen a pregnant woman in their lives—except for themselves in the mirror. Everything we do, we have a control group who are healthy, who don’t take the product. They don’t have access to these women.”

Koren scolds Health Canada for its 2005 Paxil advisory: “The government never talked to any psychiatrists, not to us, not to any experts. They just took what Glaxo told them, including telling women to stop taking the drug in the third trimester. I don’t have words to tell you how irresponsible that is,” he says, referring to the nasty side effects that can accompany sudden SSRI withdrawal.

GSK acted responsibly, he says: “They ran to the government the minute they thought they saw something. They were the first to think that Paxil had more cardiac malformations.” He brushes off criticism that the unit’s research is biased by pharmaceutical funding. No SSRI research is funded by the drug’s manufacturers, he says, although Eli Lilly has provided research grants and Apotex, which produces paroxetine, has funded a Motherisk study of fetal alcohol syndrome. “I wish they would give us money,” he jokes. “Eli Lilly refused to give us money,” he says of Motherisk’s attempt to get funding for a study involving its drug Prozac. Companies are wary of conflicts of interest, he continues: “Glaxo refused to give us money. They don’t want to be seen as if they support that research because it will mean that they want you to take that medication.” Koren rejects the criticism that Motherisk research is “drug tainted,” pointing to its studies that showed serious fetal risks associated with corticosteroids and lithium.

Yet industry money can influence outcomes, as exposed by the scandal arising from hematologist Nancy Olivieri going public with what she believed to be serious side effects in deferiprone, a drug to treat a childhood blood disorder she was researching with Koren. He sent out vicious, anonymous letters to discredit Olivieri, then denied doing so until presented with DNA evidence. A later investigation revealed behaviour unimaginable from the editor of Textbook of Ethics in Pediatric Research: Koren also put his name on reports drafted and co-authored by Apotex-funded researchers that used Olivieri’s data but didn’t mention risks she’d identified; he gave incorrect and false testimony against Olivieri. He also failed to disclose a $250,000 “miscellaneous” grant from Apotex that continued to rely on his research to defend its drug with regulators and in court actions.

Sick Kids initially sided with Koren and Apotex, and removed Olivieri as head of the research program; she was later reinstated. Koren was reprimanded by the University of Toronto, the hospital, and the Ontario College of Physicians and Surgeons, which termed his behaviour “childish, vindictive and dishonest.” He was slapped with a six-month suspension (four with pay) and fines, resigned from two positions and lost another administrative position as well as a research chair, though he kept his Motherisk post.

Today, Koren bristles at any suggestion of personal conflicts of interest. “I’ll sue you if you say I’m involved with drug companies,” he says. He later clarifies that he works with the industry, and his Motherisk biography notes that he is a paid consultant to Duchesnay. A Sick Kids 2002 research disclosure shows Koren received $240,000 from Duchesnay between 1994 and 2002. Drug companies don’t market to pregnant women, Koren says: “All of them tell women not to take medication—unless the benefit is beyond the risk.” Now that knotty risk-benefit equation is about to be tested by Bartram vs. GlaxoSmithKline and a spate of new U.S. lawsuits against other manufacturers. Maybe they’ll bring us closer to understanding what exactly is at risk here—and just who benefits. Pregnant women need to know, and they’re not alone.

]]>http://www.macleans.ca/society/life/theres-a-pill-for-that/feed/3Why does Alexandra as a royal baby name sounds so familiar?http://www.macleans.ca/society/life/why-does-alexandra-as-a-royal-baby-name-sounds-so-familiar/
http://www.macleans.ca/society/life/why-does-alexandra-as-a-royal-baby-name-sounds-so-familiar/#commentsThu, 11 Apr 2013 19:25:04 +0000http://www2.macleans.ca/?p=370462Well, not to brag, but our resident royal watcher picked that name months ago

So after weeks of being consigned to the bargain basement of possible royal baby names, Alexandra has surged in recent days from 10:1 odds to a 2:1 favourite. (Even “Barack” makes an appearance, at 200:1, mind you.)

Well, way back in December–when the pregnancy was initially announced–everyone was plumping for Elizabeth, or possibly Diana.

Yet, within hours of the news that Kate was in hospital with acute morning sickness, I’d created a list of my favourite names for the future monarch—five for a girl and the same number for a boy, along with my reasonings. The first choice? Alexandra (Philip was my top pick for a boy).

While no one is going to know who’s right and who’s wrong until the baby is born—Kate recently said it’s due mid-July—it’s kinda nice to think the world is coming around to my way of thinking. At least in Britain’s gambling shops.

Did Kate spill the beans that she’s expecting a daughter? For all those not following the kerfuffle, a recap. During a visit earlier this week to Grimsby earlier, Kate was handed a teddy and thanked the lady for the gift.

A woman who overheard the exchange told reporters that Kate said, “Thank you, I will take that for my d…” Speculation flew that Kate meant “daughter,” accidently revealing that she was carrying the future queen regnant. Then, as people examined video of the incident frame by frame, doubts set in. Did she mean “dog”—her young cocker spaniel Lupo—but stopped because it would be rude to say she was going to use the gift as a canine chew toy?

On Lisa’s footage, Kate is heard to say, “is this for us, awww, thank you so much, it’s very sweet of you” when given the soft toy “for the baby” by wellwisher Diana Burton.

Grimsby resident Sandra Cook, 67, who was standing nearby at the time thought the Duchess had said “is this for our dau…” before stopping abruptly. She then asked Kate when she reached her along the line: “Did you say my daughter?”

In light of the new footage, it’s no wonder the Duchess looked so confused at Mrs Cook’s question before raising an eyebrow and wagging her finger to deny she knows whether she’s expecting a girl.

]]>http://www.macleans.ca/authors/patricia-treble/a-definitive-answer-to-kates-daughter-or-dog-comment/feed/1A daughter for Will and Kate could create a royal headachehttp://www.macleans.ca/news/canada/a-royal-headache/
http://www.macleans.ca/news/canada/a-royal-headache/#commentsThu, 03 Jan 2013 21:00:01 +0000http://www2.macleans.ca/?p=332989Colby Cosh on the Constitutional problem of a female heir

Is there perhaps a silent prayer sweeping stealthily across the ranks of Canada’s constitutional experts? “Please, Lord, let the duchess of Cambridge be delivered of a fine, healthy heir. And if you could see to it, let it be a boy. Or, if it’s a girl, make sure she only has younger sisters.”

When St. James’s Palace announced on Dec. 3 that the wife of HRH Prince William was great with child, the machinery of the Commonwealth was ready. The heads of government in the Queen’s various realms had, in October 2011, already agreed to a co-ordinated change in their statutes that will allow the Prince’s children to succeed in order of seniority, irrespective of sex. The necessary changes to British law, which affect acts as far back as 1351, are ready for parliamentary approval and scheduled to go through as early as possible in the new year, with the Canadian ones to follow. There is nary a whisper of dissent from any quarter.

But on Dec. 4, a couple of troublemakers—University of Ottawa professor Philippe Lagassé and graduate student James Bowden—took to the pages of the Ottawa Citizen to chirp a warning. Since 1931, Canada has had an independent throne that happens to be occupied by the same person who occupies the U.K.’s. This is a fine point on which all monarchists agree; indeed, they get positively snippy when someone refers to our “British” sovereign.

And it’s universally recognized that Canada must separately ratify any change to the succession of Canada’s throne. The U.K. no longer makes law for us. The Privy Council Office has announced specific plans to implement the change in federal Parliament, and the government has a promise of enthusiastic support from the New Democratic Opposition.

But the Constitution Act of 1982 says that any amendment to Canada’s Constitution “in relation to the office of the Queen” has to have the unanimous consent of the provincial legislatures as well as the Senate and the House of Commons. The natural meaning of the phrase “office of the Queen,” Bowden and Lagassé point out, would seem to include succession arrangements. (Their position has found support from the University of Sydney’s Anne Twomey, who argues that the same problem exists in Australia with regard to its states.) Certainly the old U.K. laws now being amended have always been considered part of the Canadian Constitution.

So do the provinces need to sign off on the trendy change in favour of gender equality? And could one province block it, either now or in the distant future?

The Privy Council Office’s view is “no.” PCO spokesman Raymond Rivet acknowledges that “there are a lot of opinions being put forward about that,” but says the official view is that “there are no constitutional implications” involved in the succession change. The Canadian legislation, says Rivet, merely “signals Parliament’s agreement” to the changes being made in the U.K.

As the Ottawa scholars note in the Citizen, there is pretty much just one piece of Canadian case law relevant to the issue: O’Donohue v. Canada, a 2003 case from Ontario’s Superior Court in which a Roman Catholic challenged the Act of Settlement of 1701 on the grounds that the exclusion of Catholics from the throne was discriminatory. Unfortunately, Justice Paul Rouleau did not exactly succeed in making the issue clearer. He confirmed that the royal succession rules are part of the Constitution: that’s a point explicitly against the view the PCO is now trying to carry off. He also noted that the preamble to the old British North America Act of 1867 guarantees that we will have the same monarch as Great Britain—a “symmetry” that is “axiomatic” to our Constitution.

Score one for the PCO. But at another point Rouleau appears to question the axiom; he suggests that if Canada had not ratified the 1936 abdication of Edward VIII—which it did—it might not have been in force here, raising the possibility that the Canada-U.K. personal union of thrones could be broken unless all the i’s are dotted and the t’s are crossed. After all, if the common identity of the sovereign is “axiomatic,” why was any action by Canada’s Parliament necessary when Edward quit?

The good news is that the current order of succession is all male (not counting the person at the top) through the life of 30-year-old Prince William. The oddball possibility of a vexatious provincial challenge to the succession arises if his wife has a baby girl first, followed at some point by a boy. Many subjects are probably hoping this will come about; there has been good luck with female monarchs since Mary I. But from the standpoint of the law, a boy would be . . . just . . . easier, okay?

With the global population ballooning to seven billion, Science-ish wonders whether journalists around the world are in on a conspiracy to lower birth rates by scaring would-be parents with crazy stories about pregnancy risks. Consider the headlines this week: We learned that “depression in pregnancy can slow a child’s development” and that a mother’s fish and mercury intake is linked to attention-deficit hyperactivity-disorder behaviours in her kids.

This isn’t just the result of a slow news week. Science-ish has been tracking the health stories targeted at expectant parents over the last year, and they have ranged from the silly to the farcical, and always with a dash of fear mongering.

Last September, the BBC reported that eating low-fat yogurt—not the Greek, or half-fat types—during pregnancy may induce asthma and hay fever in children. The Guardian reported on a study that linked a mother’s sleeping position to stillbirths, recommending specifically that she sleep on her left side or else risk having one. Would moms be able to sleep at all after that chilling report? Fox News wrote: “Mother’s hypertension during pregnancy may affect child’s IQ later in life” and that “Women who get pregnant while dieting increase babies’ obesity risk.” And there was no shortage of reporting on the scary chemicals in our environment that can harm wee ones, even before conception. A telling headline from Mother Nature Network: “BPA exposure linked to abnormal egg development.”

In an effort to figure out where and how media reports go so off the rails, Science-ish called the lead author of the new study on mercury, fish consumption, and ADHD behaviours in children. Sharon Sagiv of the Boston University School of Public Health explained that the problem—in the reporting on her study and others—is that research is too often taken out of context, lonely islands isolated from the body of literature on the same subject.

“I would never use a single study to base a recommendation on,” she said. Different studies on the same thing can have vastly different conclusions; they should be taken together as a whole to correct the quirks, biases or methodological flaws in the one-offs. “When you read a health headline, put it in perspective,” she concluded.

In fact, she said her newest study—published in the Archives of Adolescent and Pediatric Medicine—is consistent with the body of literature that shows eating fish during pregnancy is important to neurodevelopment but that there are adverse effects related to eating too much mercury. On the specifics of the ADHD link, she said that the research is fairly new. As well, there were some limitations to her study: the participant dropout rate was high, which means that the findings may have been skewed; mothers’ fish consumption was self-reported and people are not always reliable sources of information about their eating habits; and the study was based on a relatively small group of people living in one community, not necessarily a representative sample.

“While I’m glad this study is getting press,” she said, “my hesitation is that people read these stories and change their behaviours based on one study.”

Dr. Helle Kieler, a professor at the Karolinska Institute in Stockholm, has looked at the effects of anti-depressant use in moms—a source of much anxiety in the headlines. In an email to Science-ish, she wrote that it’s difficult to give general recommendations for medications during pregnancy, but if there are safe and effective alternative treatments available, parents should explore them. “This is the case for mild and moderate depression and anxiety disorders, where psychotherapy could be offered to a greater extent instead of SSRIs,” she added. “We know very little about the effects and adverse effects of SSRIs during pregnancy.”

Her advice to expectant parents was to go beyond media reports before panicking or modifying behaviour. “Find out what kind of study was reported,” she said. “Was it an animal study or were humans involved. What kind of risks are reported. If relative risks, one would want to know in relation to what. Was it a rare or more common outcome and did they report absolute risks.”

With the hope of soothing the worries of expectant parents, Science-ish conducted an informal survey with researchers who look at pregnancy and safety, asking for their evidence-based advice. Most of it was plain common sense, the stuff your grandmother would tell you. Eat a balanced diet and maintain a healthy weight. Don’t smoke. If you drink, make sure it’s only half a glass and infrequently. Don’t use drugs, and do your research* if you need to use medications because we simply don’t know the long-term effects of many of them. That boring stuff doesn’t make the news, though. So Science-ish would add: take the headlines with a grain of salt.

*Check out the Science-ishguide to searching for health information on the web.

Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the associate editor at the Medical Post. Got a tip? Seen something that’s Science-ish? Message her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto

]]>After searching the Internet in a hypothetical emergency, a surprising proportion of college students fail to discover that emergency contraception can be purchased without a prescription, according to a new study. Researchers from Northwestern University asked about 200 college students to search the Internet and then advise a friend who called them late at night asking how to avoid pregnancy from unprotected sex. Only two-thirds recommended emergency contraception like plan B and less than 40 per cent suggested the easiest option—purchasing it over-the-counter at a pharmacy. Some suggested “wash genitals,” or “pregnancy test.” In Canada, plan B is available in pharmacies without prescriptions in all provinces except Quebec. For more, see MyHealthNewsDaily.

]]>http://www.macleans.ca/education/uniandcollege/students-confused-by-emergency-contraception/feed/0How Leah McLaren nearly crossed the TMI line with the Queenhttp://www.macleans.ca/society/life/how-leah-mclaren-nearly-crosses-the-tmi-line-with-the-queen/
http://www.macleans.ca/society/life/how-leah-mclaren-nearly-crosses-the-tmi-line-with-the-queen/#commentsFri, 04 May 2012 18:29:38 +0000http://www2.macleans.ca/?p=257132The Canadian London correspondent just penned a cover story for the Spectator quite unlike the one she wrote 10 years ago

]]>Leah McLaren just landed on the front page of the Spectator with a tale of how the Queen nearly got an earful from her in response to a regally innocuous and unmistakably British “How do you do?” at a Buckingham Palace reception. The Canadian London correspondent had just found out she was pregnant and had to restrain herself from crossing the “Too Much Information” line with Her Maj.

On the way home she burst into tears.

“I wasn’t crying because of the baby — in fact I was delighted to be pregnant — I was crying because I was having a child with a Englishman who was firmly committed to England. And that meant I could never go home.”

And with this, McLaren has come full circle. For ten years ago, she made waves with another Spectator piece, one tellingly titled: “The tragic ineptitude of the English male.” Back then, she now writes:

“I concluded as a result that most British males were borderline alcoholic, fearful of women, socially and emotionally retarded and, because of the archaic boarding school system (I confined my dating to a small west London sample), probably repressed homosexuals as well.”

Flash forward a decade and McLaren is not only knocked up, but head over heels in love.

“And so, after prematurely dismissing all Englishmen out of hand, I have, to my astonishment, discovered that the best ones can be funny and clever and kind and generally unflappable. Better yet, I have found one with whom I’m very happy to make a life. That he is not boarding school-educated or from what he calls ‘the soft south’ (a place, up until now, I have pretty much thought of as ‘England;’ and a place that Rob, hardly the professional northerner, openly adores) may have something to do with it. To be honest I’m not entirely sure, nor do I really care.”

]]>British Columbia: Cougars in Pacific Rim National Park on Vancouver Island have stunned researchers, who found the wildcats have been eating seals. Analysis of their scat showed their meals also included river otters and sea lions. Although they’re strong swimmers, there’s little chance the cougars braved the surf to go fishing: likely, they preyed on young or sick animals near the shoreline.

Alberta: Researchers at the University of Calgary have found that bad moods can spike cortisone levels in pregnant women, which in turn can affect fetal development, since cortisone plays an important role in the formation of children’s lungs and brains during gestation.

Ontario: The debate over spanking as punishment is never-ending. New research bolsters those seeking a ban: spanked children tend to become aggressive adults, and they’re more likely to use drugs and alcohol, according to a study co-authored by the Children’s Hospital of Eastern Ontario. The study also found that spanking children can lead to depression and anxiety.

Quebec: Kids won’t ask for fast food if they don’t see it on TV, according to a study of Quebec households by UBC researchers. Junk food purchases were down 13 per cent in Quebec, which bans fast food commercials during children’s programming, the study found. Quebec, researchers noted, has Canada’s lowest childhood obesity rates.

Nunavut: Killer whales eat anything they can catch, according to Inuit hunters, who have dubbed them “wolves of the sea.” And with melting sea ice attracting more and more orcas to the Arctic, local hunters fear they’ll have to compete for food with the fearsome predators, according to new research by the University of Manitoba. The whales often tear into narwhal and “play soccer” with their parts, hunters report, and they’ve seen bowhead whales “rammed” to death by a group of much smaller killer whales.

]]>http://www.macleans.ca/news/canada/dont-worry-be-happy-when-expecting/feed/0Studies say: having a job won’t make you happyhttp://www.macleans.ca/news/canada/having-a-job-wont-make-you-happy/
http://www.macleans.ca/news/canada/having-a-job-wont-make-you-happy/#commentsWed, 05 Oct 2011 14:10:13 +0000http://www2.macleans.ca/?p=217497Our semi-regular roundup of findings from the world of academia

]]>British Columbia: Researchers have determined that it’s harder for gay couples and single parents to get an apartment in Vancouver. Gay couples are 25 per cent more likely to be rejected by landlords than heterosexual couples, while single moms and dads are 15 per cent more likely to be rejected than married couples with children, according to a study by University of British Columbia sociologist Nathanael Lauster.

Alberta: University of Alberta researchers have found evidence that “brain wiring”—the development of paths in the brain caused by learning—continues well into young adulthood. New social experiences and post-secondary education were cited for continued brain development after the bursts of childhood and adolescence.

Ontario: It’s true: in spring, a young man’s (and woman’s) fancy turns to thoughts of love. A Queen’s University study has found teenagers are more likely than adults to conceive during the month of March. Citing spring break as the likely reason, co-author Mary Anne Jamieson suggests schools conduct sexual health blitzes before letting students loose for holiday frivolity.

Quebec: Despite what we wage-slaves might want to believe, having a job doesn’t make you any more likely to be happy. The Université de Montréal has found that people who don’t work and aren’t looking for a job are often less stressed and happier than those who are employed. Those who work in stressful, non-fulfilling environments are often miserable since they tend to take downtrodden feelings home with them.

Maritimes: According to a new study comparing home-schoolers with students in the public school system in Nova Scotia and New Brunswick, kids taught at home were better off, as long as their lessons were structured. On average, home-schoolers scored a half-grade higher in math, and two grades higher in reading.

Dr. Aaron Caughey is the chairman of the Department of Obstetrics and Gynecology at Oregon Health and Sciences University, director of its Center for Women’s Health, and a researcher with an interest in diabetes in pregnancy. He recently addressed the pushing question at the Birth World Congress in Chicago.

Q: What attracted you to obstetrics?

A: I’m a labour-floor junkie. As a third-year medical student doing an obstetrics rotation, it was immediate for me, like a crush. The process of birth, the intensity of the experience, the potential for it to be many people’s best days mixed with a small percentage of people’s worst days, and the challenge of how to make the outcomes better—it’s extremely compelling.

Q: Let’s start with a brief refresher course on labour.

A: The first stage of labour goes from the beginning of contractions until a woman’s cervix is completely dilated, the second stage is from the beginning of when she starts pushing until the baby delivers, and the third stage is from the delivery of the baby until the delivery of the placenta. The first stage of labour is divided into two phases: latent and active. The latent phase was really defined by Emanuel Friedman in the 1950s and 1960s.

Q: But the Friedman curve continues to influence guidelines about the length of time a woman should labour before medical intervention is indicated, right?

A: Right. Let’s say a woman has dilated to six centimetres, time is passing, and there’s no change. The older research indicates you should wait at most for two hours, then move on to a Caesarean or forceps delivery. However, the more recent work of OB/GYN Dwight Rouse and others shows that for women who are in spontaneous labour, if you just wait another two hours, 60 per cent will deliver vaginally.

Q: But Friedman’s research is what you’d be taught in medical school, right?

A: Most textbooks probably only mention the Friedman curve.

Q: Do midwives follow the two-hour rule?

A: Some midwives, depending on how they’re trained, can be pretty adherent to strict guidelines like the two-hour rule. But others, like someone who’s breaking from traditional obstetrical care and might even offer home birth, might let a woman who’d reached six or even eight centimetres stall out for a matter of hours. They’re just much more patient.

Q: Was Friedman’s research sloppy?

A: No. This was years before the personal computer. The sample sizes were relatively small because data analysis by hand is quite challenging. Some of the biostatistics we can do today just weren’t possible. But in terms of the study design, his methods are right on and anyone doing labour curves today uses them.

Q: Why do the newer curves look so different from Friedman’s, then?

A: His population was mostly Caucasian women in spontaneous labour. The populations we take care of today are very different. The rate of obesity has doubled in the last 15 years, and obese women tend to have bigger babies and tend to be in labour longer. The other thing that’s changed is the use of the epidural. In Friedman’s studies, the rate of use was about eight per cent, but on most labour floors today it’s between 70 and 90 per cent. The epidural slows labour down. Many times, in the first stage, after an epidural you’ll see a decrease in the rate of contractions. In the second stage it’s blockading your nerves, so you have less motor strength and can’t push as hard.

Q: You’re an advocate of letting women stall even after they’re fully dilated, and say there’s no big rush to push. Why not?

A: This is called “delayed pushing” or “labouring down.” Before epidurals, this probably wouldn’t have occurred to anyone to do, because once a woman is fully dilated and the baby’s head starts moving down in the pelvis there’s enormous pressure on the pelvic nerves and that gives the woman an enormous urge to push. But with an epidural, you’re blocking not only the motor connection, the ability to push, but you’re also blocking the sensation, the pain. And in that case, women don’t feel that strong urge, they can wait.

Q: But why wait?

A: We know the second stage takes longer with an epidural, so now you have women pushing so long, three or four hours even with totally normal births, that they get tired. If you’re in a clinical setting where three hours of pushing is used as an upper bound—at three hours, it’s called a prolonged second stage of labour—and you’ve barely been able to move the baby because you’re weak from the epidural, someone is going to say, “Oh gosh, the baby hasn’t come down, it’s time for your forceps delivery or a C-section.” The idea of labouring down is to say, “If you want to allot three hours for pushing, then why don’t we let the uterus do some work for an hour or so, get the baby down a little more, then the mom can start to push—and she’s less likely to need a C-section.”

Q: That just sounds like common sense.

A: Exactly. I’ve been doing it since the mid-’90s. In the biggest and best-known randomized study—the lead author, Bill Fraser, is Canadian—900 women pushed early and 900 waited for a couple of hours. In the delayed pushing group, there were less of what they characterized as difficult deliveries, which included C-sections and mid-pelvic or higher-up forceps deliveries. The women pushed on average about 68 minutes in the delayed arm, versus 110 minutes in the other arm. However, the total length of the second stage of labour was about an hour longer because of the delay.

Q: Were their babies just as healthy?

A: The vast majority of babies are just fine. However, in the delayed arm, in a very small percentage of cases, there was more maternal fever, and it does seem that the babies of women who have maternal fever are at risk for some bad long-term outcomes. The second thing is that a very small percentage of the babies of women who delayed pushing had slightly lower pH or acid levels. When pH is low, you start worrying about injuries to the baby’s brain.

Q: So what would you advise a woman who’s in labour, not progressing after two hours, whose doctor is urging a C-section?

A: She should hand Dwight Rouse’s paper to her doctor, and say, “No, let’s make sure we have the oxytocin at the right levels, and we should wait at least four hours.”

Q: Is a C-section really such a big deal?

A: It is major abdominal surgery, and what’s not discussed enough with women is what it means for future pregnancies. Many hospitals won’t even let you try to deliver vaginally next time.

Q: Is there an incentive for a physician to order a C-section even if it’s the woman’s first pregnancy?

A: The physician doesn’t make that much more for a Caesarean delivery, about 10 per cent more in the U.S. For the physician, the main incentive is related to time and convenience. If I’m on call all weekend, and I’ve got somebody in labour who’s been six centimetres dilated for a couple of hours and it’s 5 p.m. on a Friday—well, if I do a C-section now, I might get to leave the hospital to see my family. If I give her two more hours, and she dilates further, that still doesn’t mean she’s ready to deliver. It could be midnight before she’s completely dilated, and then she could push for three or four hours, and at the end, I’m paid about the same as if I’d just done the C-section 12 hours earlier.

Q: Today, about 33 per cent of births in the U.S. are Caesarean deliveries, and you co-authored a study that says that if current trends continue, by 2020, 56 per cent of births will be by C-section. Is the problem that doctors just can’t be bothered to wait?

A: My gut is that the biggest contributor is the legal environment. If something goes wrong and you get sued, you’re going to spend weeks to months in a courtroom—and there’s all that lost revenue to your practice while you’re sitting there—being described by the plaintiff’s attorney as one of the most evil people to walk the earth since Hitler. Adam Smith described incentives in economics as the invisible hand—they’re in your subconscious. I think if you polled 100 honest physicians, none of them would say, “My incentive was to get home at five.” But it’s there, it’s the natural incentive. And I think they’re trying to prevent bad things happening to their patients. The reasoning is, “As soon as you’re slightly abnormal [deviating from the Friedman labour curve], I think you’re at risk for shoulder dystocia or some other bad outcome for your baby, so I’m going to do a C-section. Why take any chances?”

Q: From a health standpoint, what’s wrong with a C-section?

A: You’re more likely to have a hemorrhage, or a postpartum infection. Someone with a prior C-section has a higher risk of a placenta previa or a placenta accreta, which is where the placenta is either covering the cervix or eating into the wall of the uterus, so you may require a hysterectomy. And you’re more likely to die if you have a C-section.

Q: How much more likely?

A: The chances are about one in 100,000. What’s way more likely is that you’re stuck having more C-sections in the future.

]]>http://www.macleans.ca/general/on-labour-how-epidurals-changed-childbirth-and-why-women-dont-have-to-push-so-much/feed/7Are home births safe?http://www.macleans.ca/society/health/dont-try-this-at-home/
http://www.macleans.ca/society/health/dont-try-this-at-home/#commentsFri, 26 Aug 2011 15:30:53 +0000http://www2.macleans.ca/?p=210146Home births may need less intervention and cause fewer injuries for mom. But they may be riskier for babies.

Jon Barrett is accustomed to dealing with anxious mothers-to-be. As chief of maternal-fetal medicine at Toronto’s Sunnybrook Health Sciences Centre, one of the main concerns he hears from patients involves unnecessary medical interventions during delivery.

He acknowledges that the rate of Caesarian sections and episiotomies is far too high in Canadian hospitals. “A healthy young woman, coming into this hospital now for delivery, has almost a 40 per cent chance of having some sort of intervention that is not desired.” But he’s more unnerved by what that phenomenon appears to be triggering: a surge in demand for home births.

In Ontario, midwives performed 2,360 home births in fiscal 2008, an increase of 23 per cent in just five years. There are no national home birth statistics but the percentage of non-hospital births more than tripled in Canada between 1991 and 2007 (the latest year for which statistics are available), although they remain well under two per cent of total births. That rate is typical of much of Western Europe and the U.S.; the notable exception is the Netherlands, where roughly a third of women give birth at home.

Barrett’s concerns about home births stem from experience. Between 1990 and 1992, he was part of an obstetric “flying squad” in Newcastle, England. His job was to travel, by ambulance, to the bedsides of women whose home births had gone awry. “For two years of my life, I remember going to calls of people who got into trouble at home,” he recalls. “I just remember disasters.”

Two incidents are particularly vivid. The first occurred in winter. Navigating the ambulance through snowy laneways, Barrett’s team arrived to find two midwives frantically working over an unconscious woman. She was in shock and hemorrhaging badly. “I’ve never seen so much blood in my life.” She survived, but only after a massive blood transfusion in hospital. The second woman developed pre-eclampsia, which caused seizures, and went into cardiac arrest as his ambulance pulled up. His team was able to restart her heart and intubate her before rushing her to hospital. She also survived. He says both conditions were unpredictable and could have occurred anywhere, “But I know they would have come less close to dying if it would have happened in hospital.”

Unlike some of his colleagues on the squad who witnessed fetal deaths during home births, if Barrett’s memories were reduced to pure data in a typical study, they’d be unremarkable. That’s because most home birth data measures deaths, not complications, and his patients survived. “If you want a retrospective study, there’s no maternal mortality there . . . and so is that safe? No, it’s just bloody lucky.”

The question of how best to measure home birth safety has long plagued researchers. In Canada, national statistics don’t track birth outcomes by home versus hospital. Nor do they track the sorts of near-tragic outcomes described by Barrett. Yet what is counted— mortality rates for mothers and babies during childbirth—offers little insight on the maternal side because, in the industrialized world, maternal deaths from childbirth are rare. In 2007, 24 women died in Canada from pregnancy-related conditions, including delivery, compared to more than 4,000 stillbirths and deaths within 28 days of delivery. But stories like Barrett’s suggest the numbers don’t tell the whole story. In his view, the bottom line should be obvious: “Sooner or later you’re going to get a disaster because that’s the nature of obstetrics.” He adds, “It’s very rare that it will happen, but it’s got to happen more in home birth.”

That assertion is at the heart of a furious debate in the birthing community. Mothers who choose to give birth at home often cite research showing there are fewer medical interventions and no increased risk. But in the past year, a new study has emerged that contradicts this. It shows that home births are associated with significantly higher death rates for babies. If correct, the rights of women to control their own bodies and birth experience would seem to conflict with the best interests of their children.

When the American Journal of Obstetrics and Gynecology (AJOG) released the now-controversial “Wax Study” last summer, it created the medical equivalent of the Rift Valley amongst birthing experts. Led by U.S. obstetrician Joseph Wax, of the Maine Medical Center, it confirmed significant benefits to mothers who gave birth at home, including less hemorrhaging, vaginal tearing and epidural use, and fewer infections and Caesarean sections. Unfortunately, these benefits seemed to occur at the baby’s expense: shockingly, the report showed that neonatal deaths (defined as deaths within 28 days of birth) were two to three times higher for home births. Clearly, no woman who chooses home birth believes she’s jeopardizing her baby’s health, but the study suggested such faith in the safety of home birthing is undermined by medical evidence. For those who accepted Wax’s results, the benefits of giving birth at home suddenly appeared trivial compared to the risks.

In many ways, Wax’s study was groundbreaking. Because few women would agree to be arbitrarily assigned a birthing location, there are no randomized trials (the gold standard for accurate research) on home birth safety. Instead, researchers often fall back on “cohort” studies that analyze existing data, such as birth records. The biggest problems are selection bias—deciding which data to include—and, in the case of home births, self-selection: high-risk women tend to gravitate to hospitals while those more likely to opt for home births tend to be low-risk. There can also be issues with record-keeping; for example, if a home birth mother transfers to hospital because of an emergency, and her baby dies in hospital, it may be recorded as a hospital death, rather than a home birth death. Wax’s study, a meta-analysis, combined and re-analyzed existing studies, in order to create a bigger sample and, ideally, a more accurate result. He looked at more than 230 peer-reviewed papers published between 1950 and 2009, and selected a dozen that compared planned home births with planned hospital births by low-risk mothers in industrialized countries (Australia, Sweden, the Netherlands, Switzerland, Canada and the U.S.). The study’s vast scope—it encompassed more than 500,000 deliveries—boosted its credibility. As one doctor put it, “half a million births cuts out a lot of noise.”

Perhaps, but the momentary silence was followed by an outraged roar from home birth supporters, including some whose research showed very different results. “The Wax study is full of mathematical errors,” says Patti Janssen, a professor at the University of British Columbia’s School of Population and Public Health, and lead author of a 2009 cohort study that showed home births to be as safe as hospital births, for women and babies. “The design was wrong, and the calculations were wrong, and it just has to be thrown out the window.” Her objections encompass everything from Wax’s math to the studies he chose to exclude from analysis, and were published on Medscape.com in April in a critique whose co-authors include Ank de Jonge and Eileen Hutton, both lead authors of studies that conclude that home births are as safe, if not safer, than hospital births.

In the avalanche of media attention that followed, Wax initially defended his work, but then began refusing interviews, including for this article. As a flood of letters poured into the AJOG, some demanding the study be pulled, the publication convened an independent panel to examine the main complaints. In April, it published a sample of those letters, along with a detailed response from Wax. It also released the panel’s conclusion that the study did not need to be retracted.

But the debate has continued, and gained force, in the wake of a second study, led by Annemieke Evers out of the Netherlands. Published in the British Medical Journal last November, it concluded that babies born to low-risk women, under a midwife’s care (in hospital or at home) are more than twice as likely to die as those born to high-risk women who give birth under an obstetrician.

Although these results were specific to Holland, and may indicate problems in the way the Dutch system categorizes women as “low- risk,” the study nevertheless provided fresh ammunition to those who believe babies are best delivered by obstetricians, and added fuel to the home birth debate. More letters began to fly, adding to the stack of seemingly contradictory information through which pregnant women are required to sift in order to make an educated decision.

Nathalie Waite could be the poster mother for the perfect home birth. Waite’s considerations were largely pragmatic when she decided, two years ago, that her fifth baby should be born at home. She had four children attending three different Toronto schools, no nanny, and wanted her delivery to disrupt life as little as possible. It wasn’t a decision she made lightly. Her husband was nervous, but Waite’s midwife reassured them both. They lived near a hospital. Two attending midwives would be in close contact with Waite’s obstetrician and, at the slightest sign of trouble, an ambulance would be in her driveway. Most importantly, Waite knew her own body. She’d had four hospital births. During the two deliveries in which she’d fought—“and I had to fight because they always wanted to hurry the process”—for a natural birth she’d experienced far less pain. “By this time I was very well versed. I understood my pregnancies and I understood what kind of deliveries I have.”

Had she known what a home delivery would be like, Waite says none of her children would have been born in hospital. “It was purely beautiful.” While she laboured on the top floor of the house, her children played cards on the ground floor. Her husband checked on her between bouts of gardening, while her visiting parents kept an eye on the household. “I was left alone upstairs, peacefully, hearing all the activity happening through the house and it just felt so natural. It just felt right.”

This is why home births are special, says Anne Wilson, president of the Canadian Association of Midwives. “It’s a non-medicalized environment where birth becomes a normal part of your family life.” And they are safe, she stresses, in the standard response of home birth advocates: “Research says that for women experiencing low-risk birth, that outcomes are the same, in home or in hospital, with a lower risk of intervention.”

While the Wax study argues that outcomes aren’t the same, there is no debating the fact that home births have lower intervention rates. And everyone, on both sides of the argument, agrees that hospital intervention rates are too high. “In my opinion, the cascading interventions in hospital births start when the woman walks in the door,” says Tyler Shaw, the father of two children born at home.

His daughter’s birth, in Kingston, Ont., in 2007, was such “a spectacular experience” he and his wife decided to repeat it at their new home in Guelph this year. Unfortunately, their son was born with fluid in his lungs, which concerned their midwife enough to send them to hospital. Everything they experienced from that point on, Shaw says, reinforced their preconceptions. Their son was given blood tests, a chest X-ray and an IV for a condition Shaw believes would have cleared up on its own after several hours. They had to fight for permission to breastfeed (the doctors were concerned the liquid would enter the baby’s lungs) and, he says, when the pediatrician went home without leaving instructions for release, their son remained in an incubator for an additional 15 hours. “Our rights were completely taken away and doctors more or less said this is what we’re going to do to your baby and there’s nothing you can do about it.”

A musician, who also has a bachelor of education and master’s degree in environmental studies, Shaw’s mistrust of the medical system runs deep. “I’ve hung around scientists enough to be skeptical of everything I’m told,” he states matter-of-factly. He and his wife refused vitamin K and erythromycin ointment for their children, two treatments hospitals and midwives administer as standard protocol after birth. (Vitamin K ensures the baby’s blood can clot until it starts making the vitamin itself, and erythromycin is an antibiotic that protects against infections from the birth canal that can cause blindness.) It was the words of his sister, a doula, that convinced him and his wife to take that stand. “She said that a baby has the right to having a whole, intact, unadulterated body and that we should try to protect that right as a baby’s parents.”

In many ways, Shaw and Waite represent opposite ends of the home birth spectrum. Certainly Shaw’s rejection of many of the fundamental tenets of modern medicine contrasts with Waite’s attempt to adapt its benefits to a home birth. But they share an important piece of common ground: both chose to deliver their babies with the help of a midwife.

Freebirthers, women who deliver without assistance (and often shun prenatal care), represent the smallest sub-section of home birth mothers, and aren’t included in studies on home birth safety. Among their most famous advocates is Janet Fraser, an Australian woman who made famous the term “birth rape” to describe an emergency episiotomy during the birth of her son. “I don’t care if you don’t like the word or the idea, it’s real so get used to it,” she wrote on her site, JoyousBirth.info. “When you shove your arm in a woman who’s screaming no, that’s rape. When you rupture those membranes because you have to tick the box and comply with ‘protocol’ even when the woman screams no, that’s rape. When you slash a woman’s vagina with scissors and she’s screaming no, that’s rape and on the street it would earn you a jail sentence.”

In 2009, Fraser’s baby daughter died after five days of home labour. She continues to advocate for freebirth.

Freebirthers make most midwives nervous and they horrify obstetricians. Freebirth is the equivalent of playing “Russian roulette with your child,” says André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada (SOGC). “You don’t play with a child’s life. Especially not where [health care is] free.” That said, the SOGC does believe that midwife-assisted home births are “a reasonable alternative for low-risk women.”

Yet, asked if he would consider home birth a reasonable option for his family, Lalonde is unequivocal. “No. Definitely not.” He falls back on experience for explanation. “I’ve participated in over 6,000 deliveries in my career and I know that everything looks very fine and suddenly disaster strikes.”

That conflict between medical experience and faith in a woman’s body to deliver naturally lies at the heart of the home birth debate. But is the concept of natural childbirth in danger of being romanticized? The ideal of the less-medicalized birth experience, as extolled in Naomi Wolf’s 2001 book Misconceptions, has become part of the zeitgeist. There is a documentary, popular amongst home birth advocates, entitled Orgasmic Birth; its website invites viewers to “witness the passion as birth is revealed as an integral part of woman’s sexuality and a neglected human right.” Ami McKay’s award-winning novel The Birth House makes a compelling case for home births to a more mainstream audience. In it, the doctor is portrayed as a condescending, patriarchal figure who knocks out his protesting patients with ether, then yanks out their babies. In contrast, the methods of midwife Dora Rare are equally suspect (think mandrake root and witchcraft) yet portrayed with exquisite humanity. Even when things go wrong, the women are in control, being cared for by women.

That kind of experience need not be exclusive to home birth, insist obstetricians. “We should be working to make the environment of the hospital conducive to the home birth experience, rather than having more deliveries at home,” Sunnybrook’s Barrett says.

But midwives like Anne Wilson maintain there’s nothing to equal the experience of a home birth. “If I am delivering a baby in the hospital, you’re a guest in my house. If I’m delivering a baby at home, I’m a guest in your house. And there’s quite a lot of psychological difference there.” Wilson hopes the demand for home births will continue to rise in Canada. That said, she believes that all low-risk women, including those who choose to give birth in hospital, should deliver with a midwife.

That’s the system adopted by the Netherlands—and the Evers study suggests it’s failing dramatically. Amy Tuteur, an American obstetrician/gynecologist, thinks that the study’s results are just common sense. One of the harshest critics of home birth, Tuteur’s blog, The Skeptical OB, takes an unflinching look at labour and challenges the assumption that it’s best left to Mother Nature.

“Childbirth is inherently dangerous,” she writes. “In every time, place and culture, it is one of the leading causes of death of young women. And the day of birth is the most dangerous day in the entire 18 years of childhood.” Educated at Harvard College and Boston University School of Medicine, Tuteur in her blog shines a harsh light on much of the romanticism surrounding home births, and includes first-hand accounts—harrowing and heart-breaking—of women whose babies died during home births. “Why does childbirth seem so safe?” she continues. “Because of modern obstetrics. Modern obstetrics has lowered the neonatal mortality rate 90 per cent and the maternal mortality rate 99 per cent over the past 100 years.”

Until recently her views, not surprisingly, were echoed by the American College of Obstetricians and Gynecologists (ACOG). But in January the college softened its position, replacing its formal statement against home birth with a committee opinion recognizing that women have the right to choose, although they should be made aware of the risks, including those highlighted in the Wax study.

That change represents a huge step away from attitudes that were considered paternalistic, says Richard Waldman, president of the ACOG. More importantly, it allows the debate to shift from trying to prevent home births to making them safer. “I don’t think it’s that important to debate whether it’s safe, safer or not safe. I think it’s very important to debate how we can make home birth safer because women are going to do it anyway.”

In the United States, one way to improve safety is by improving midwifery. Training and regulations are a patchwork across the country; in some states, midwives aren’t even required to finish high school. In that respect, the U.S. lags many industrialized countries, including Canada. It’s one of the reasons Canadian midwives bristle at comparisons.

In contrast to the U.S., our midwives are university educated, highly regulated, and well-trained in emergency skills, notes Vicki Van Wagner, Waite’s midwife and an associate professor of midwifery at Ryerson University. They can ventilate a newborn, provide oxygen, and stabilize a hemorrhaging mother with an IV and anti-coagulant drugs before sending her to hospital for a blood transfusion. While they can’t administer an epidural or oxytocin, or perform surgery, they’re trained to recognize warning signs and transfer patients to hospital if such treatment appears likely to be needed. “It may be that there are some problems that occur, very rarely, at home that would be better served in hospital, but there are problems, like infections, that occur in hospital as well,” says Van Wagner.

Obstetricians and midwives are in broad agreement on the key measures necessary to reduce risk during home birth. They are the steps taken by Waite: ideally, a low-risk woman would deliver with the assistance of two highly trained midwives who are in close contact with an obstetrician at a nearby hospital. When those steps are put in place, Wald­man says, “it can work almost as safely as the hospital situation.”

Is “almost” good enough when you’re talking about the survival of a newborn baby? Although he describes himself as a long-time supporter of midwives and birthing centres, the ACOG’s Waldman echoes his Canadian counterpart, Lalonde, when he says he wouldn’t want a home birth for his wife or daughter. “The intrapartum loss rate has got to be higher at home, it’s just intuitional for anybody who does this work. How big that number is could be debated.”

And is being debated. As larger and larger studies are undertaken, Sunnybrook’s Jon Barrett believes the data will start to show consistently higher risks associated with home births—and science will remain a lightning rod. “There’s such a powerful natural childbirth lobby that anyone who publishes something like that is going to come under a lot of criticism, justified or unjustified.”

]]>A simple blood test can determine a baby’s sex as early as seven weeks into the pregnancy, according to findings in The Journal of the American Medical Association reported by TheNew York Times. This test analyzes fetal DNA in the mother’s blood and can pinpoint sex much earlier than other options, including ultrasound. It’s also non-invasive. These tests have been available at drugstores and online for a few years but they haven’t been too popular, partly because of uncertainty over how accurate they were. But European doctors now routinely use these tests.

]]>http://www.macleans.ca/general/blood-test-can-determine-babys-sex-at-seven-weeks/feed/0The women shortagehttp://www.macleans.ca/general/how-sex-selection-of-babies-has-led-to-a-huge-surplus-of-men-and-why-thats-bad-for-all-of-us/
http://www.macleans.ca/general/how-sex-selection-of-babies-has-led-to-a-huge-surplus-of-men-and-why-thats-bad-for-all-of-us/#commentsTue, 14 Jun 2011 14:05:41 +0000http://www2.macleans.ca/?p=196266How sex selection of babies has led to a huge surplus of men and why that’s bad for all of us

FLUENT IN CHINESE and Spanish, Mara Hvistendahl is a Beijing-based correspondent for Science magazine and a former journalism professor at Fudan University in Shanghai. She is the author of Unnatural Selection, about how and why rampant sex-selective abortion in Asia is skewing the entire world’s gender balance.

Q: The natural sex ratio at birth, resulting in equal numbers of men and women, is 105 males to 100 females. But in Asia, that ratio has been skewed for a generation, and demographers calculate there are now over 163 million women “missing” from the continent’s population. Which countries have been most affected?

A: The areas most affected are eastern China and northwest India—the most developed parts of those nations—as well as South Korea, Taiwan and northern Vietnam. The important thing is that it’s beginning to appear in other parts of India and China.

Q:Lately it’s come to Asian immigrant communities in North America, and nations where it was not expected, like in Eastern Europe.

A: That’s right. Very few people anticipated that you’d see sex selection in Albania and Azerbaijan, Georgia, Armenia.

Q:Is the ratio in the Chinese port city of Lianyungang, 163 boys to 100 girls among children under five, the highest on record?

A: Yes, although I think there were periods in the ’90s where some South Korean cities had a ratio at birth of over 200. On record, the worst areas are somewhere above 150.

Q:It’s clear what has to come together for this to occur: rapid modernization, access to ultrasound machines to determine fetal sex and access to abortion, and an overall drop in fertility.

A: A drop in fertility, yes, absolutely necessary. Across Asia it’s gone from 5.7 children per woman to 2.3 in 40 years, but that figure is for all of Asia: in the sex-selection hot spots, the number of children a woman has is between one and 1.5. The same for the new areas. Armenians are at 1.3, Georgians at 1.4, Azerbaijanis have fewer children than Americans. Then you need access to ultrasound, and that abortion be available. As the birth rate falls in a country where a high premium is placed on sons, there’s more pressure on women to ensure that one of those children is a son.

Q:Abortion as the normal birth control method seems key, making it easier to consider ending a pregnancy over gender. Do you agree?

A: It’s crucial that abortion is legal and available. A Korean sociologist told me, “Look, if Korea didn’t have the history it does of not only abortion but other population control methods being heavily encouraged and sometimes forced on people, I don’t think that we would have the same degree of sex-selective abortion today.” But I would stop short of saying that this is entirely about abortion. My book is really a technological history, and it’s a book about bioethics. We’re developing new sex-selection technologies now and those have nothing to do with abortion. Sex selection during the in vitro fertilization is a Western variation. I don’t think campaigns against sex selection should turn into campaigns against all abortion.

Q:Is that why you don’t use the emotionally loaded terms that other people use about what’s happening: gendercide, feticide?

A: As I was preparing this book I was struck by how U.S. abortion politics had come to bear on the issue, and it’s a loaded issue for both the right and the left. I do believe in a woman’s right to terminate a pregnancy. And while anti-abortion groups in the U.S. are pushing through bans on sex-selective abortions, their goal is not to increase the number of women in the world, per se, but rather to establish a precedent for the fetus being a life. So it’s a difficult thing to talk about. The right wing uses words like gendercide and feticide, and the other extreme is people on the left who don’t use the word abortion at all, when what’s happening is abortion.

Q:I understand it is a difficult issue, especially for pro-choice women.

A: Yeah, but what’s important to remember is that the context surrounding abortion in Asia is completely different from in the West. In the U.S., a woman often has to brave picket lines if she wants to get an abortion. Sometimes there aren’t clinics in her town. In Asia, in the countries where sex-selection occurs, abortion is pervasive. In China, abortion clinics advertise on prime-time television, and it’s just very different.

Q:That’s the familiarity aspect of abortion. But I want to ask about the cascading effect of sex selection. How does that occur?

A: The marriage squeeze? There are two dynamics at play. The Asian generations born in the ’80s are much larger than those that will come after, even while there are fewer women in them, meaning fewer potential mothers. One demographer I spoke with called it a double whammy. That’s one challenge. At the same time you have this marriage squeeze—the first generation of surplus men may marry women who are a few years younger, because they have trouble finding women their age. But the shortage trickles down, so for later generations the situation is much more dire, with single men competing not just against their own generation but against an existing surplus of older males.

Q:One possible end result is the South Korean situation. There the natural ratio has been restored because now couples’ number preference—one child—overwhelms their gender preference. Korea is like Japan, with equal numbers of boys and girls but, really, no children.

A: The average Korean woman only has about 1.1 or 1.2 children. The preference for male children remains after a first child, but for the most part people are just having one.

Q:In terms of global social implications, you note, scathingly, that some economists think the value of women will rise with their relative rarity. You’re not impressed?

A: That’s an idea that’s been put forth since the ’80s. It seems like a way to wash your hands of the issue: it will balance itself out, we don’t have to do anything. Yes, a commodity like oil, as it becomes scarce, the price goes up and people fight over it, and that’s what’s happening, in a crude way, with women. But women don’t control that value.

Q:Implications for women are often dire?

A: From Taiwan and Korea, where we had sex selection early and men now can’t find wives, bachelors go on marriage tours to Vietnam. They pay $10,000 and that covers the flight to Ho Chi Minh City and room and board. Once they arrive they go to a hotel and the women are basically village women who are sold by their parents and they’re lined up for the men to pick from.

Q: In the couple you focus on, I was struck that the Vietnamese bride was the ninth of 10 children, a family number now unheard of in Taiwan, as it is here. Among the many unexpected consequences of the gender imbalance is that this process may turn out to be so profitable in areas like the Mekong Delta that there will be a selective pressure to have girls—just another, more lucrative, agricultural crop.

A: There is a globalization of marriage going on. In the very poor parts of the world, people now see an advantage in having daughters. One island in the Mekong Delta has sent so many women to Taiwan that it’s called Taiwan Island. The families that send women there are better off, and they have more appliances, they have bigger homes, and the island on the whole is doing very well. It’s, yeah, a bit of a business.

Q:And if that is a business, about which we could shrug our shoulders, we are also witnessing increases in sex trafficking, in forced marriages and even honour killings. That would be examples of the new value of scarce women going to men, not to the women themselves?

A: Right. One story I featured in the book is of a 15-year-old girl in Vietnam who was chatting with a boy on the Internet. When she showed up to meet him in Hanoi she was kidnapped, shoved across the border to China and put to work in a brothel. I included that because an increase in prostitution is one of the effects of the gender imbalance. As for forced marriages, there are stories of women being forced to marry multiple brothers, of girls being bought very young and families who raise them until they’re old enough to marry their sons.

Q:Then there’s the male response?

A: There will be millions of men, most of them at the bottom of the social ladder, who can’t find wives and most won’t be happy about it. Compare high sex-ratio areas where the men are now grown to low ratio areas, and there’s higher crime and more violence. If you look back at history, it was never great to have a huge surplus of men. Look at the Wild West in the U.S., or the settlement of Australia—areas racked by violence. The modern world has never seen an imbalance on this level.

Q:And violence not just between the men themselves but to women, too.

A: Violence toward women, that’s an important thing to remember. A lot of sex crime. In India there have been reports from the northwest, where the sex-ratio imbalance is worse, of rape and sex crime on the rise. The case has been made in the past that this situation—say 20 million single, angry and usually nationalistic young men in China—is a security threat for the West. A U.S. defence contractor told me the Pentagon is keeping a close watch on China’s surplus men. Time will tell, but we shouldn’t focus on the supposed threat of China or India attacking us, or people overwhelming our shores. We should really care about the gender imbalance because it’s a huge human rights issue.

Last week, at the G8 summit in Deauville, France, Carla Bruni-Sarkozy, supermodel-turned-wife of the French president, greeted her fellow first wives in what was quite obviously a white maternity smock.

After exchanging air kisses with such lesser-known political spouses as Svetlana Medvedev, wife of the Russian president, Geertrui Van Rompuy-Windels, wife of the European Council president, and our very own Laureen Harper, Ms. Bruni-Sarkozy and her lady friends posed for an obligatory photo op. As the cameras zoomed in on her burgeoning baby bump (a.k.a. the worst-kept secret in Europe), Bruni smiled coyly and motioned to her belly. “Sooner or later it’s gonna come out,” she said—an observation that is as correct on a political level as it is a biological fact.

Earlier this year, Nicolas Sarkozy’s approval ratings slumped to an all-time low, with the worst polls showing that a scant 21 per cent of the country approved of his leadership. Then-unconfirmed rumours that his 43-year-old wife was pregnant (apparently with twins via IVF treatment, if you believe the tabloids) did not initially seem to give him much bounce in the polls. But with the surprise career implosion of former IMF head Dominique Strauss-Kahn (who until recently was widely touted as Sarkozy’s top political rival), the French president’s prospects for re-election in 2012 are looking somewhat brighter.

Surely it cannot hurt that his wife—an Italian-born heiress who once dated Mick Jagger and declared that monogamy “bored” her—appears to have successfully shifted her image from glamazon songstress to glowing expectant mother. Unofficial confirmation of the couple’s pregnancy came when Sarkozy’s own father let it slip to a German newspaper that the couple did not yet know the baby’s sex, but that he was “sure it’ll be a girl who’ll be just as beautiful as Carla.” For the twice-divorced Sarkozy, who ruffled French conservative feathers when he married Bruni in 2008, shortly after splitting with his former wife, the chance to play the family man comes at a politically opportune moment.

The next French election campaign will heat up in October, around the same time Bruni-Sarkozy is reportedly due. While it’s impossible to deny that her pregnancy is conveniently timed, only the most cynical commentators have condemned it as a publicity move. Columnist Anne Perkins recently wrote in the Guardian that the Sarkozy marriage is “an exercise in vanity which leaves only the most credulous supposing the pregnancy is a happy accident.”

The assumption, of course, is that the French first couple is attempting to emulate the winning British formula of “first-fathers” who have impregnated their spouses while running for—or having been recently elected to—the nation’s highest offices. Indeed, the last three British prime ministers—Tony Blair, Gordon Brown and David Cameron—all fathered children while in office (Brown was chancellor of the exchequer at the time), a fact that helped to humanize their respective public images.

Whether Sarkozy’s impending fatherhood will result in a public relations boost remains to be seen. At 56, he already has three sons from his two previous marriages (Bruni-Sarkozy also has one son with a former lover). Even with a fecund Carla blooming at his side, he will have to work hard to overcome his reputation as an ineffective leader who has failed to revitalize the French economy as promised.

Still, as Perkins points out, there is undeniable social currency in becoming a political daddy. “Paternity is both the ultimate triumph of the macho and the stage on which the politician can legitimately perform the father-protector role,” she wrote. “It is an artifice that conceals the less saleable truth: that politics is a question of the ruthless exercise of power. Family authenticates humanity.”

Samantha Cameron’s very visible campaign-trail glow, which resulted in a baby girl born in August last year, was credited with giving the Tories an early lead in last year’s British election campaign. And like Ms. Bruni-Sarkozy, Sarah Brown, Cherie Blair and Samantha Cameron all had their most recent pregnancies relatively late in life (at 39, Cameron was the youngest of the bunch, at the time of her youngest child’s birth, by several years). This similarity suggests that, as a tribe, European political wives are particularly willing to brave the potential health risks of a late-in-life pregnancy in exchange for the payoff. But are they having more children in an effort to aid their spouses’ careers? It’s impossible to know for sure.

Carla Bruni-Sarkozy’s popularity in France has vacillated over the years. While she was once voted the nation’s “most irritating celebrity,” one recent poll found that she and Sarkozy were the country’s best-loved celebrity couple—an honour that suggests they are stronger together than apart. Now, with a new baby on the way, Bruni-Sarkozy’s star status seems set to soar to new heights. But while her pregnancy is obvious, for now she’s still refusing to flaunt it. As she recently said in a public interview, “My lips are sealed to protect something and to protect all the work [my husband] does. I would really like to talk about it, but then it would take over everything else.”

]]>A month-long sting by Chinese police nabbed an unlikely group of criminals: a band of pregnant thieves. Dubbed the “Big Belly Gang,” the decade-old maternal crime ring is allegedly responsible for the majority of the 3,000 cases of in-store thefts reported at shopping malls in the city of Hangzhou last year. Operating in groups of five, three non-pregnant women would distract staff while two pregnant women stole goods from the store, or money and valuables from other shoppers. While their stay-at-home husbands watched their children, the group met each day at the local school’s gates to divide their loot, splitting it 60-40 between the non-pregnant members of the gang and those stealing for two.

The gang exploited China’s leniency toward pregnant women and new mothers, who can plead a “special situation” and be released almost immediately (the gang’s boldest member was arrested and released 47 times). Relying on anonymous tips and help from informants, police moved in and captured all 47 members of the ring, 22 of whom were pregnant and also bulging with loot at the time of arrest. Police have recovered about 1.5 million yuan worth of goods stolen by the gang, but say it’s just a fraction of the group’s haul.

]]>http://www.macleans.ca/news/world/mommies-gone-wild/feed/0What to expect when she’s not expectinghttp://www.macleans.ca/society/health/what-to-expect-when-shes-not-expecting/
http://www.macleans.ca/society/health/what-to-expect-when-shes-not-expecting/#commentsWed, 30 Mar 2011 16:00:08 +0000http://www2.macleans.ca/?p=179124A man who's lived through it has advice for men whose wives can't get pregnant

For six years, L.A. comedy writer Mark Sedaka and his wife, Samantha, tried to have a baby. ” ‘Unexplained infertility’ is all we were ever told,” he writes in a new book for men called What He Can Expect When She’s Not Expecting: How to Support Your Wife, Save Your Marriage and Conquer Infertility. “More often than not,” he explains,”we poor schlubs are left to fend for ourselves—not quite sure when to chime in, when to keep quiet, when to take action, and when to lay low.”

As for what to expect first, he warns men about “a little thing called procreation sex. In other words, the planned mandatory acts of copulation that will be required as your wife charts her monthly cycle.” Expect all spontaneity to disappear from your sex life, he writes. “You’re pretty much going to know a day in advance that you will be having sex tomorrow. Not might be. Will be. It’s gonna sound pretty much like when she asks you to take out the garbage for the umpteenth time.” All you can do, he tells men, is to calmly explain to her that “you don’t mind being told when you’re going to have sex as much as you mind being told 30 times.”

Ask her not to lie about it, either, he writes: “Now that you’ve made her self-conscious about the whole procreation sex thing, she’ll probably avoid the subject altogether and opt instead for the old, ‘I’m so horny tonight’ routine. Do they think we’re that dumb?”

On the social front, he tells men: “Your job description must also now include running interference every once in a while. I wouldn’t go so far as to tell your friends to ‘shut the hell up’ whenever they ask your wife how it’s going, but a quiet aside after the fact would certainly go a long way to making her feel more comfortable and secure.”

Expect, too, that your wife won’t enjoy the company of other children. “It’s just too painful,” he writes. “I even made the difficult choice not to invite one of my wife’s best buddies to her 35th birthday party because his wife was six months pregnant at the time. Sorry, Gary,” he writes.

Then there are the hCG shots. “Never heard of it? Oh, you will, my friend. A word of warning about the hCG shot: because of the crucial timing, your wife will be insane with taking the shot exactly 35 hours before her scheduled egg retrieval [for in vitro fertilization]. She will mention it incessantly, she will set about three alarm clocks, she will make sure all the flashlights in the house are working in case there’s a blackout. Just go with it, guys. Smile, nod and think about baseball.”

Sedaka warns that most fertility drugs are not administered orally. “And get this? You are going to be expected to give the shots. I’d love to tell you that after a while I became more comfortable with it, but I can’t. If anything, it only became more unpleasant as her skin started to harden and scar from all the days of abuse. I’d also love to tell you that I became consistently better at it, but I can’t tell you that, either. In fact, on the very last shot, I hit my wife’s sciatic nerve and left her limping for about three weeks. Maybe that’s because I never looked. Never. I would pick a spot, make a mental image, close my eyes, and go.”

To explain the importance of the embryologist during in vitro fertilization, Sedaka writes: “Imagine him as the general manager of a professional football team. In this case, he’ll start with the defence—also known as eggs. Out of 20 or so recruits, a few will be cut immediately. Too mature, not mature enough, lacking a chromosome or two, you know the drill. Now it’s time to call up all those offensive sperm cells who have been waiting patiently on the bench. In a sort of ‘open tryout’ the whole lot of them will take to the field, also known as a petri dish, and enter into a fierce skirmish with the defensive eggs. Most will be eliminated early on, but a few lucky players will rise to the occasion. If the number of sperm cells proves inadequate, however, then open tryouts are cancelled and one single sperm cell will be chosen as an early draft pick.”

On Jan. 29, 2003, Sedaka and his wife became parents of twin daughters through a gestational surrogate. “In all, six years, three states, five doctors and $250,000. Yikes!”

]]>http://www.macleans.ca/society/health/what-to-expect-when-shes-not-expecting/feed/9Baby, Can I have a drink?http://www.macleans.ca/society/health/baby-can-i-have-a-drink/
http://www.macleans.ca/society/health/baby-can-i-have-a-drink/#commentsMon, 27 Sep 2010 16:57:16 +0000http://www2.macleans.ca/?p=148990Doctors and their female patients of child-bearing age need to start talking about alcohol consumption

Until now, a doctor wouldn’t usually ask a woman having a routine pap smear how many drinks she enjoyed that week. But new national guidelines recommend that alcohol consumption become a regular topic of conversation between female patients of child-bearing age and their physicians. “We’re not here to moralize or be pejorative,” says Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, and a co-author of the report. “This is a question of awareness and harm reduction.”

The guidelines, published in the August edition of the Journal of Obstetrics and Gynaecology of Canada, recommend that doctors ask women who are or could become pregnant about their drinking habits, and record that information in their charts. Previous guidelines focused on diagnosing cases of fetal alcohol spectrum disorder, which affects as many as three in every 1,000 births, and results in neurological and behavioural problems.

Given that half of pregnancies are unintended, and that most Canadian women imbibe, comfortable dialogue is critical, say experts. Unfortunately, many physicians admit that they don’t broach the subject for fear of shaming their patients. That’s why the guidelines offer doctors suggestions on how to ask about alcohol consumption in a “supportive” and “motivational” way.

The guidelines also aim to alleviate the anxiety women experience after learning they’re pregnant—and realize they’ve had a few drinks. “We’re fairly comfortable saying there’s no need to terminate, and chances are there hasn’t been an effect,” explains Senikas. In fact, the guidelines take into account that some studies show “low level” alcohol consumption doesn’t have a negative impact. The trouble is defining how much is too much. “The most prudent choice,” says Senikas, “is to abstain.”

]]>It seems there’s a lot of conflicting advice about whether pregnant women should eat fish, or avoid it due to concerns over high mercury levels. What do you think?The concern is real. Pregnant women should not eat fish that are high in mercury. It is also good to rotate and eat different types of fish in your diet.

What is the “stress hormone” cortisol, and how does it affect our bodies?
Cortisol is your “stress response hormone.” Your body secretes it in response to physical or emotional stress. It prepares your body to meet physical or emotional challenges by increasing your heart rate, blood pressure and level of alertness. It helps us defend against an “attack.” While cortisol is a survival hormone, chronic stress creates a high level of this ‘fight or flight’ hormone, which causes undesirable mental and physical effects. It engenders survival instincts–quick decisions based on minimal analysis. Sharp strategic thinking ability is impaired. Caffeine is a major stimulator of cortisol secretion. Too much caffeine might make you more alert but not a smarter thinker! Insulin–secreted in response to cortisol–causes sugars (from ingested carbohydrates) to move out of our blood stream and stored in the form of fat–increasing overall body fat and weight. As blood sugar levels decline, ‘brain fog’ ensues.

]]>It was early in the morning when Kimberlie Bunch woke up with excruciating stomach cramps and nausea. As the aching in her right side got worse, she worried that her appendix might burst. When Bunch’s boyfriend came home from work, he found her writhing in agony, surrounded by unexplained blood splatters. They rushed to the ER, where the nurse asked if Bunch was pregnant. The answer was an unequivocal no: Bunch was using birth control, had irregular periods, and hadn’t gained weight.

But within minutes, a doctor told Bunch that she was in labour. “At that point I thought I was dreaming,” recalled Bunch on an episode of I Didn’t Know I Was Pregnant, a paranoia-inducing TV show documenting women who experience a condition called “denial of pregnancy.” Unlike concealment of pregnancy, which occurs when a woman hides the fact that she’s expecting, denial of pregnancy happens when she is unaware of being pregnant. After Bunch gave birth, she was dumbfounded. “You’re taught all these things that you should expect when you’re pregnant, like morning sickness and weird cravings,” she said, “but I never had any of that.”

Bunch’s story is shocking, but not unique. Although no Canadian statistics exist, a German study showed that for every 2,455 pregnancies, one woman won’t know she’s expecting until she delivers the baby. (A Welsh study found a similar ratio, one in 2,500.) In fact, denial of pregnancy is three times more likely than having triplets. “The common view that denied pregnancies are exotic and rare events is not valid,” concluded pioneer Jens Wessel at University Clinic Charité in Berlin in the 2002 study.

Of the 65 Berlin women with denial of pregnancy, 42 weren’t diagnosed until they were in labour or their third trimester. Many had been pregnant before, and their median age was 27. Nearly all the mothers kept the baby, and carried to full-term. Astoundingly, four sets of twins were delivered. Most of the women were employed, had a relationship with the baby’s father and lived with their partner.

Stunned moms abound. Last month, April Dawn Halkett of Prince Albert, Sask., was acquitted of abandoning her baby after she unexpectedly gave birth in a Walmart washroom and then fled. In the U.K., two days before last Christmas, Tina Cook didn’t know she was having a baby “until I got to the hospital and felt the head.” Labour pains have been mistaken for the flu, cancer, cysts and kidney stones. Jamie-Lynn Spears apparently had liposuction while she was unknowingly pregnant. And a new memoir called What I Thought I Knew by New York playwright Alice Eve Cohen describes how her pregnancy, at age 44, was misdiagnosed as menopause.

These women face one question: “ ‘How did you not know for nine months?’ ” as a mom said on the TV show. When she didn’t get her period, she took pregnancy tests for two months, and all were negative. (Halkett testified that she took three tests and none indicated she was pregnant.) Researchers suspect that some women possess a chemical that obscures the test’s ability to detect pregnancy, but that’s rare, says Charles W. Simpson, a professor at the University of Saskatchewan and a gynecologist-obstetrician who testified at the Halkett trial.

Similarly confusing is the irregular bleeding these women mistake for a period. In the Berlin study, 46 per cent of the women had their periods during pregnancy, some for eight months or longer; 12 per cent had irregular cycles. The authors called this a “mystery.” Another 15 per cent had been on birth control pills.

What’s more, some women pack on so few pounds that they assume their tightening waistbands are due to overindulgence. Others carry so much excess weight that manifest­ations such as a growing belly or a baby kicking go undetected. Simpson, who has delivered babies in two cases of denied pregnancy, says that one patient was massively obese. “There would be no way we would know she was pregnant based just on looking at her,” he recalls.

There is also the question of clarity of mind. Simpson says that half of these women have a psychiatric disorder such as a delusional syndrome. But in the Berlin study, mental illness was present in only three of 65 participants. “The majority of the recruited women were ‘normal,’ ” wrote the authors.

Tremendous risks are associated with denial of pregnancy. Drinking can cause fetal alcohol syndrome, says Simpson, and smoking leads to low birth weights. Without prenatal care, maternal problems such as high blood pressure, pre-eclampsia and gestational diabetes may go undiagnosed. Where the mother delivers unexpectedly and alone, the baby may not progress through labour properly, says Simpson, or receive enough oxygen.

That’s why researchers such as Wessel have called for greater awareness of denial of pregnancy. “There seems to be,” Wessel has written, “no other condition as dangerous and potentially lethal to mother and child that is being ignored.” Not for long.

]]>http://www.macleans.ca/society/health/baby-surprise/feed/7More powerful than a book clubhttp://www.macleans.ca/culture/more-powerful-than-a-book-club/
http://www.macleans.ca/culture/more-powerful-than-a-book-club/#commentsThu, 25 Jun 2009 19:40:00 +0000http://tearsheet.ca/dev/?p=4277Four women form a group dedicated to allowing each of them to realize a dream

]]>When graphic designer Amy Mead dreamed of having a baby, she took an eccentric step. She joined forces with a group of women. It wasn’t a pregnancy group. Each woman had a different goal but all shared the belief that a group’s collective energy has more power than any one individual’s. If anything, it was a support group for desires.

At the time, Mead was 38 and worried she’d blown her chances of getting pregnant by waiting too long. “There’s strength in numbers. I was thinking along those lines,” she said recently from her home in Florida, now that she’s a mom, and now that her group has just published a book. Three years ago, the women hardly knew each other, now all four are the joint authors of The Group: An Amazing Way to Achieve Success, Happiness and Extraordinary Relationships. Tiffany Kaharick is a massage therapist. Rebecca Carswell is a hypnotherapist and professional speaker. Mirja Heide runs a computer training company. They all live in Florida. “We just began with the idea of: how can we achieve more?” says Heide. “We sat around a table discussing very openly what we wanted to get out of the group,” remembers Mead.

Heide wanted to go to Africa but was afraid to travel alone. “It was a lifelong dream. I don’t typically share really heartfelt things and here I was sharing it with the group and this was the beginning. The group believed in me and then I began to believe in myself. When you speak about a dream, it gets more substance. When it’s just in your mind, you can put it behind.” Heide’s dream of Africa had sat on the back burner her whole life. “But when it’s vocalized, it’s out there. The group asked questions to find out what it was that was keeping me from travelling. Then I started taking action steps.” Within months, Heide had put down money with an organization called Earthwatch and was well on her way to studying elephants in Namibia.

The group meets once a month on Sundays. No food or alcohol is served. “When we want to have drinks and jibber-jabber, we go out and we do that,” says Mead. “But for our group meetings, it’s very focused and clearly defined. Our meetings start at 7:30 and go to 9:30 and every minute of those two hours is designated in segments. If we started with a glass of wine, it would lose its effectiveness.”

The meetings focus on one woman at a time. “The Honoured One” has the full hour, explains Heide. When the Honoured One speaks, the others listen without interrupting. “Interruptions,” explains their book, “include interjecting your own thoughts and opinions or physically hugging or touching the speaker. Physical touch, in an attempt to comfort someone, can be distracting and stop the flow of thoughts and emotions.”

When there are pauses, “Allow the silence. Remain quiet and listen.” Do not say, “Oh yeah, that happened to me, too! I know exactly what you mean” and proceed to tell your story. Do not be a problem-solver. “You may feel a need to have the right answers or impress the group with your knowledge.” Resist the urge to tell the Honoured One “what you would do in that situation, or what you’ve done in the past.”

Heide says the group is “therapy for us but better than therapy because it’s free. And you leave with an action plan. There are so many obstacles in life and you can get pretty burdened but this is the kind of thing you can come to the meeting with and unload it and then turn it around and ask, ‘How can I manage my life so I don’t feel so overwhelmed?’ ” Mead says the group helped her clear away self-defeating thoughts. “I believe this helped me relax and trust, which in turn helped me become pregnant.”

When one group member succeeds, the whole group celebrates “naturally.” The book italicizes the word naturally to emphasize the reaction isn’t phony. “You don’t have to force yourself to feel this way,” they write in a section on jealousy. “If you ever feel jealous of what others have, you are not alone. In our competitive society, we are not typically taught to celebrate the success of others. Another’s success can make us feel inadequate.” Jealousy is blunted the longer you are a member of the group, they write. “Imagine listening to a fellow member share a dream. At the next meeting, she shares a step she took toward this dream. Two meetings later, she announces she has reached her goal. You are just as excited as she is because you supported, encouraged and believed in her.”

]]>http://www.macleans.ca/culture/more-powerful-than-a-book-club/feed/0Your Eggo Is Preggo!http://www.macleans.ca/authors/jaime-weinman/your-eggo-is-preggo/
http://www.macleans.ca/authors/jaime-weinman/your-eggo-is-preggo/#commentsWed, 22 Oct 2008 20:24:50 +0000http://macleans.wordpress.com/?p=13668Alyson Hannigan is pregnant, news that (as the link implies) makes it very likely that her character will become pregnant too. Her character is at the point where it would…

]]>Alyson Hannigan is pregnant, news that (as the link implies) makes it very likely that her character will become pregnant too. Her character is at the point where it would be plausible and a good source of story ideas for her to have a baby.

There are two options regarding a TV actor’s pregnancy: write the pregnancy into the show, or try to hide it. Both have their problems. When you hide it, you get those Seinfeld episodes where Julia Louis-Dreyfus spent all her scenes behind the counter in Jerry’s apartment, or those Cheers shows with Shelley Long behind the bar for 23 minutes. But unless a character has already been set up as wanting to have a baby, writing the pregnancy into the show often feels awkward and ridiculous — like Cybill Shepherd’s pregnancy on Moonlighting, or various pregnancies on Friends. CSI: NY is doing a whole elaborate pregnancy story that may or may not turn out something like that. And whether or not the pregnancy scenario is plausible, something worse is always on its way: once she has the baby, the show is stuck with that baby for a long time (unless they want to engage in SORAS, and that’s no longer fashionable in prime time). The child is always forgotten as the character gets back to doing what she was doing before, and we wonder why she’s not spending any time with her kid.